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目的探讨后腹腔镜下离断式肾盂成形术的临床应用价值。方法采用经后腹腔途径实施腹腔镜下离断式肾盂成形术治疗肾盂输尿管连接部(UPJ)梗阻25例。男22例,女3例。B超检查：肾盂扩张积水＜15 mm(轻度)4例,15～30 mm(中度)15例,＞30 mm(重度)6例。IVU检查：30 min内显影良好16例,30～120 min淡显影6例,120 min未显影3例。结果25例手术均成功。手术时间150～240 min,平均170 min；术中出血量30～120 ml,平均70 ml；术后住院时间6～8 d,平均7 d。未发生明显外科并发症。25例术后均随访3～14个月,IVU显示UPJ吻合口无狭窄,肾功能显著改善,30 min内显影良好22例,30～120 min淡显影3例。肾积水明显减轻,肾盂扩张积水消失16例,轻度6例,中度3例。结论后腹腔镜离断式肾盂成形术微创、安全、有效、术后恢复快,可望作为UPJ梗阻治疗的有效手术方法。
Objective To investigate the clinical value of retroperitoneal laparoscopic pyeloplasty. Methods 25 cases of ureteropelvic junction obstruction (UPJ) were treated with laparoscopic pyeloplasty by retroperitoneal approach. There were 22 males and 3 females. B-ultrasound: pyelonephrosis <15 mm (mild) in 4 cases, 15-30 mm (moderate) in 15 cases,> 30 mm (severe) in 6 cases. In IVU examination, 16 developed well in 30 min, 6 developed pale in 30 to 120 min and 3 in 120 min. Results 25 cases were successful. The operation time ranged from 150 to 240 minutes (average 170 minutes). The intraoperative blood loss was 30 to 120 ml with an average of 70 ml. The postoperative hospital stay was 6 to 8 days with an average of 7 days. No obvious surgical complications occurred. Twenty-five patients were followed up for 3 to 14 months. IVU showed no stenosis of UPJ and significant improvement of renal function. Twenty-two patients developed well within 30 minutes and three patients developed light after 30 to 120 minutes. Hydronephrosis significantly reduced, hydronephrosis disappeared in 16 cases, mild in 6 cases, moderate in 3 cases. Conclusions Retroperitoneal laparoscopic disconnection pyeloplasty is a safe, effective and rapid postoperative recovery, which is expected to be an effective surgical treatment of UPJ obstruction.