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目的:探讨成人肾盂输尿管连接部梗阻的原因及腹腔镜下肾盂输尿管连接部梗阻的诊治经验。方法:对我院2006年1月～2009年3月收治的30例(32侧)成人肾盂输尿管连接部梗阻患者的病因和腹腔镜下治疗结果进行回顾性分析。结果:肾盂输尿管连接部狭窄引起梗阻者15例次(约46.8%),异位血管压迫者9例次(约28.1%),纤维索条粘连压迫者4例次(约12.5%),输尿管肾盂高位连接者4例次(约12.5%)。共行腹腔镜下手术32例次,其中离断式肾盂成形术28例次,肾盂Y-V成形术4例,纤维条索松解4例,异位血管切断3例。30例患者手术全部成功,术中无并发症发生。术中平均出血量70 ml。术后3个月～1年进行复查随访,自觉症状消失或明显好转,B超检查提示肾盂积水有不同程度减轻,排泄性尿路造影(IVU)检查患肾功能恢复良好者28例(93.3%);失访1例。结论:腹腔镜下肾盂成形术效果满意,而且损伤小、恢复快,是解决肾盂输尿管连接部梗阻的最佳方法。
Objective: To investigate the causes of obstructive ureteropelvic junction in adults and the diagnosis and treatment of laparoscopic ureteropelvic junction obstruction. Methods: The etiology and laparoscopic treatment of 30 patients (32 sides) with ureteropelvic junction obstruction admitted to our hospital from January 2006 to March 2009 were analyzed retrospectively. Results: The ureteropelvic junction stenosis caused obstruction in 15 cases (about 46.8%), ectopic vascular compression in 9 cases (about 28.1%), fibro cord adhesion oppression in 4 cases (about 12.5%), ureteric renal pelvis High connection in 4 cases (about 12.5%). A total of 32 cases underwent laparoscopic surgery, including 28 cases of interrupted pyeloplasty, 4 cases of renal pelvis Y-V plasty, 4 cases of fiber cord loosening and 3 cases of ectopic vascular dislocation. Thirty patients had successful operation and no intraoperative complications. Intraoperative average bleeding 70 ml. After 3 months to 1 year follow-up and follow-up, subjective symptoms disappeared or markedly improved, B ultrasound examination showed hydronephrosis with varying degrees of relief, excretion urography (IVU) examination in patients with good recovery of renal function in 28 cases (93.3 %); Lost in 1 case. Conclusion: Laparoscopic pyeloplasty is satisfactory, with less damage and faster recovery. It is the best way to solve the obstruction of ureteropelvic junction.