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目的:探讨俯卧位背侧入路后腹腔镜肾盂成形术治疗肾盂输尿管连接部梗阻(UPJO)的临床应用价值。方法:回顾性分析18例UPJO患者的临床资料。其中男12例,女6例,年龄18～65岁,平均31岁。所有患者行肾脏超声、静脉肾盂造影或多层螺旋CT尿路成像和逆行造影检查,其中2例行逆行造影证实迷走血管压迫,8例无症状患者行同位素肾图证实上尿路梗阻。结果:18例均在后腹腔镜下顺利完成手术。手术时间85～205 min,平均125 min;术中出血量35～80ml,平均54 ml;术后住院6～12天,平均8.7天。围手术期未出现并发症。术后4～6周拔除双J管。随访时间9～20个月,平均14.7月,1 7例痊愈,总治愈率(94.4%)。1例发生再狭窄,二次行开放手术治愈。结论:俯卧位背侧入路后腹腔镜离断性肾盂成形术治疗UPJO安全可行。经背侧入路后腹腔镜手术的成功实施为临床手术路径的研究提供一种新的思路。
Objective: To investigate the clinical value of retroperitoneal laparoscopic pyeloplasty in the treatment of ureteropelvic junction obstruction (UPJO). Methods: The clinical data of 18 patients with UPJO were retrospectively analyzed. Including 12 males and 6 females, aged 18 to 65 years, mean 31 years. All patients underwent renal ultrasound, intravenous pyelography or multi-slice spiral CT urography and retrograde angiography, of which 2 cases of retrograde angiography confirmed vagal vascular compression, asymptomatic 8 patients asymptomatic patients confirmed upper urinary tract obstruction. Results: All 18 cases underwent laparoscopic surgery successfully. The operative time ranged from 85 to 205 minutes (mean, 125 min). The intraoperative blood loss was 35-80 ml (54 ml on average). The postoperative hospital stay was 6 to 12 days (mean, 8.7 days). Perioperative complications did not occur. After 4 to 6 weeks to remove double J tube. The follow-up time ranged from 9 to 20 months, an average of 14.7 months, and 17 cases were cured with a total cure rate of 94.4%. Restenosis occurred in 1 case and the second open surgery was cured. Conclusions: Laparoscopic posterior pyeloplasty in the treatment of UPJO is safe and feasible. The successful implementation of laparoscopic surgery through the dorsal approach provides a new idea for the study of clinical surgical pathways.