腹腔镜联合膀胱软镜或输尿管软镜治疗肾盂输尿管连接部梗阻合并肾结石  

Laparoscopic Pyeloplasty Combined With Flexible Cystoscopy or Ureteroscopy for Ureteropelvic Junction Obstruction With Renal Calculi

作　　者：丁彦才 李飞宇 刘丽 杨涛 马小云 席海峰 邵永祥 王乔峰 Ding Yancai;Li Feiyu;Liu Li(Department of Urology,No.942 Hospital of PLA,Yinchuan 750021,China;不详)

机构地区：[1]解放军第942医院泌尿外科,银川750021 [2]解放军第942医院放射科,银川750021

出　　处：《中国微创外科杂志》2022年第6期459-462,共4页Chinese Journal of Minimally Invasive Surgery

摘　　要：目的探讨腹腔镜肾盂成形联合电子膀胱软镜或输尿管软镜治疗肾盂输尿管连接部梗阻(ureteropelvic junction obstruction,UPJO)合并肾结石的疗效。方法2018年1月~2021年5月我科采用腹腔镜联合膀胱软镜或输尿管软镜治疗26例UPJO合并肾结石。腹腔镜下游离扩张的肾盂和输尿管上段,在肾盂拟裁剪处先切开1 cm,置入输尿管软镜或膀胱软镜,直视下用三边或四边套石网篮取出结石,较大结石取出困难时置入钬激光碎石,结石清除后采用Anderson-Hyens法行腹腔镜肾盂成形术。结果1例术中置入trocar导致肝损伤中转开放手术。26例均一期完成手术,结石均完全清除。手术时间120~260 min,(130.1±30.3)min。住院时间(7.5±2.0)d。术后8周拔除双J管。术后3个月复查CTU示肾盂输尿管连接部通畅,肾内无结石残留,无积水加重。26例随访7~29个月,23例治愈,3例好转。结论腹腔镜肾盂成形术联合电子膀胱软镜或输尿管软镜同期治疗UPJO合并肾结石疗效满意,安全、可靠。Objective To investigate the efficacy of laparoscopic pyeloplasty combined with flexible electronic cystoscopy or ureteroscopy in the treatment of ureteropelvic junction obstruction(UPJO)with renal calculi.Methods A retrospective analysis was made on clinical data of 26 UPJO patients with renal calculi admitted from January 2018 to May 2021.Laparoscopy was used to free the expanded renal pelvis and upper ureter during the operation.The renal pelvis was incised for 1 cm at the intended cutting site,and a flexible electronic cystoscope or ureteroscope was placed.Under direct vision,the calculi were taken out with a three-sided or four-sided stone basket.The holmium laser lithotripsy was applied in case of difficulty in removing large stones.After stone removal,the Anderson-Hyens method was used to perform laparoscopic pyeloplasty.Results One case of liver injury caused by intraoperative placement of trocar was converted to open surgery.All the 26 cases were operated at one stage,and the stones were completely removed.The operation time was 120-260 min(mean,130.1±30.3 min),and the hospital stay was(7.5±2.0)d.The double J tube was removed 8 weeks after the operation.Three months after operation,review with CTU showed that the ureteropelvic junction was unobstructed,and there was no residual stone in the kidney or aggravation of hydronephrosis.All the 26 cases were followed up for 7-29 months,showing that 23 cases of hydronephrosis were cured and 3 cases were improved.Conclusion Laparoscopic pyeloplasty combined with flexible electronic cystoscopy or ureteroscopy in the treatment of UPJO with renal calculi is safe and reliable.

关 键 词：肾盂输尿管连接部梗阻 腹腔镜肾盂成形术 输尿管软镜 肾结石 

分 类 号：R69[医药卫生—泌尿科学]