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目的:探讨开放或腹腔镜肾盂成形术失败后再次行腹腔镜肾盂成形术的可行性和疗效。方法:从2004年9月~2012年5月,我们对32例肾盂输尿管连接部梗阻行肾盂成形术后再梗阻的患者采用经腹腔入路腹腔镜肾盂成形术治疗。同期开展首次腹腔镜肾盂成形术30例。术前统计两组患者的年龄、性别、体重、左右侧和积水程度,比较两组手术时间、术中术后并发症、住院时间和手术成功率,并把手术时间和术中出血与文献报道的结果相比。手术成功率以临床症状的缓解和影像学上积水和肾功能的改善来判断。两组所有数据均通过SPSS16.0专业软件进行统计,以P<0.05为差别有统计学意义。结果:术前两组患者在年龄、性别、左右侧和积水程度上的差别无统计学意义(P>0.05)。两组均无严重术中并发症,无中转开放手术者。再次手术组的平均手术时问和术中出血量多于初次手术组(P<0.05);两组患者的术后住院时间和手术成功率差别无统计学意义(P>0.05)。结论:首次的开放手术或腹腔镜手术会造成肾盂输尿管周围粘连,给再次腹腔镜肾盂成形术带来困难,但只要腹腔镜操作技术熟练,再次行腹腔镜肾盂成形术仍安全可行,还保持了腹腔镜手术微创的优点,且经腹腔途径更容易完成手术。
Objective: To investigate the feasibility and efficacy of laparoscopic pyeloplasty after open or laparoscopic pyeloplasty failed. METHODS: From September 2004 to May 2012, we performed transperitoneal laparoscopic pyeloplasty in 32 patients with ureteropelvic junction obstruction who underwent rectal obstruction after pyeloplasty. The same period carried out the first laparoscopic pyeloplasty in 30 cases. Preoperative statistics of the two groups of patients age, gender, weight, left and right sides and degree of water, the two groups were compared operation time, postoperative complications, hospital stay and operation success rate, and the operation time and intraoperative bleeding and the literature Reported results compared. The success rate of surgery to alleviate the clinical symptoms and imaging water and improve renal function to determine. All data of two groups were statistically analyzed by SPSS16.0 professional software, with P <0.05 for the difference was statistically significant. Results: There was no significant difference in the age, gender, left and right sides and degree of hydrops in the two groups before operation (P> 0.05). No severe intraoperative complications in both groups, no transfer of open surgery. The mean operation time and intraoperative blood loss in the reoperation group were more than those in the first operation group (P <0.05). There was no significant difference between the two groups in postoperative hospital stay and operation success rate (P> 0.05). CONCLUSIONS: The first open surgery or laparoscopic surgery may cause adhesions around the ureteropelvic junction, making it difficult to reconstruct laparoscopic pyeloplasty. However, laparoscopic pyeloplasty is still safe and feasible as long as the technique is technically advanced The advantages of minimally invasive laparoscopic surgery, and through the abdominal approach easier to complete the operation.