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目的:探讨后腹腔镜离断式肾盂成形术的临床应用价值。方法:回顾性分析经后腹腔镜肾盂成形术治疗的25例肾盂输尿管连接部梗阻(UPJO)患者的临床资料。其中男16例,女9例,年龄18～43岁,平均32岁。左侧14例,右侧11例。所有患者术前经静脉肾盂造影(IVP)、逆行肾盂造影(RP)或磁共振水成像(MRU)确诊。结果:25例手术均获成功。手术时间120～160 min,平均135 min;术中出血量50～100 ml,平均75 ml,无一例输血;术后住院时间5～8天,平均7.3天。术后尿漏1例。随访3～18个月,25例行IVP检查均显示UPJ吻合口无狭窄,肾积水明显改善。B超检查显示肾盂扩张积水消失20例,轻度3例,中度2例。结论:后腹腔镜离断式肾盂成形术安全、有效,充分体现了腹腔镜手术的微创优势,可以替代开放性手术,成为治疗UPJO的首选方法。
Objective: To investigate the clinical value of retroperitoneal laparoscopic pyeloplasty. Methods: The clinical data of 25 patients with ureteropelvic junction obstruction (UPJO) treated by retroperitoneal pyeloplasty were retrospectively analyzed. Including 16 males and 9 females, aged 18 to 43 years, mean 32 years. Left in 14 cases, right in 11 cases. All patients were diagnosed with IVP, RP or MRU preoperatively. Results: All the 25 surgeries were successful. The operation time ranged from 120 to 160 minutes, with an average of 135 minutes. The intraoperative blood loss was 50 to 100 ml with an average of 75 ml. No blood transfusion was recorded. The postoperative hospital stay was from 5 to 8 days (mean, 7.3 days). Postoperative urinary leakage in 1 case. All the patients were followed up for 3 to 18 months. The IVP examination of 25 patients showed no stenosis of UPJ anastomosis and significant improvement of hydronephrosis. B-ultrasound showed renal pelvis dilated water disappeared in 20 cases, mild in 3 cases, moderate in 2 cases. Conclusion: Retroperitoneal laparoscopic pyeloplasty is safe and effective, which fully reflects the minimally invasive advantages of laparoscopic surgery. It can be an alternative to open surgery and is the first choice for the treatment of UPJO.