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目的比较后腹腔镜与开放性离断式肾盂成形术治疗肾盂输尿管连接部梗阻(UPJO)的疗效。方法采用后腹腔镜途径实施腹腔镜下肾盂成形术16例(A组),同期经腹膜后途径实施开放性肾盂成形术24例(B组)。比较两种手术的手术时间、出血量、术后胃肠功能恢复时间、术后住院时间和并发症。结果两组手术均获成功,术后随访3个月～1年,吻合口均无狭窄,肾积水有不同程度改善。A组手术时间长于B组(100～200minvs.80～150min);但术中失血量少于B组(60～120mlvs.200～350ml)。A组保留导尿5～14d,术后住院时间5～13d,术后尿漏2例,均在1周内自愈。B组保留导尿5～13d,术后住院时间8～14d,术后发生尿漏3例,均在1周内自愈。结论与开放手术相比,后腹腔镜离断式肾盂成形术手术创伤小、失血量少,术后恢复快,近远期疗效相当,可以作为治疗UPJO的首选方法。
Objective To compare the efficacy of retroperitoneal laparoscopic and open pyeloplasty in the treatment of ureteropelvic junction obstruction (UPJO). Methods Retroperitoneoscopic laparoscopic pyeloplasty was performed in 16 cases (group A). In the same period, 24 cases underwent open pyeloplasty by retroperitoneal approach (group B). The operation time, blood loss, postoperative gastrointestinal function recovery time, postoperative hospital stay and complications were compared. Results Both procedures were successful. All the patients were followed up for 3 months to 1 year. No anastomotic stenosis and hydronephrosis were improved to some extent. The operation time of group A was longer than that of group B (100 ~ 200mins. 80 ~ 150min); but the intraoperative blood loss was less than that of group B (60 ~ 120mlvs.200 ~ 350ml). In group A, catheterization was performed for 5 to 14 days, postoperative hospitalization time was 5 to 13 days, and postoperative urinary leakage was found in 2 cases. All patients recovered within 1 week. In group B, catheterization was performed for 5 to 13 days, postoperative hospitalization time was 8 to 14 days, and postoperative urinary leakage occurred in 3 cases, all within 1 week. Conclusion Compared with open surgery, retroperitoneal laparoscopic pyeloplasty has the advantages of less trauma, less blood loss, quick recovery after operation, similar curative effect in short-term and long-term, and can be the first choice for the treatment of UPJO.