摘要
目的探讨后腹腔镜手术治疗双支肾静脉间输尿管所致UPJ狭窄的可行性及效果。方法患者为男性，28岁。左腰部酸痛6个月，于外院诊断为左侧UPJ狭窄、左肾积水，留置左输尿管支架管3个月后拔除。B超检查示左肾积水、左侧UPJ狭窄，CT示左侧UPJ狭窄，狭窄处与左。肾静脉关系密切，且走行于双支肾静脉之间。肾图示双肾功能受损，左肾GFR35ml／min，右肾GFR34ml／min，左肾积水，左侧上尿路机械性梗阻。全麻下行后腹腔镜下左肾盂离断成形术。结果手术顺利，术中发现左肾静脉为双支，左肾盂输尿管在。肾静脉间穿行，位于腹侧的一支肾静脉主干压迫左UPJ，同时存在肾迷走动脉与输尿管伴行人肾。术中切除狭窄段约0．5cm后将输尿管绕行至腹侧肾静脉分支前方，将肾盂成形后与输尿管吻合，同时留置输尿管支架管。手术时间240min，出血量50ml，术后住院4d，无发热、术后大出血等并发症。术后随访4个月，复查B超示肾积水明显减轻。结论双支肾静脉间输尿管所致UPJ狭窄临床罕见，可行后腹腔镜下肾盂离断成形术，创伤小，短期随访效果满意。
Objective To report a retroperitoneal laparoscopic surgery for ureteropelvic junction ob- struction （UPJO） by double renal veins. Methods A 28-year-old male patient with left low back pain for 6 months was diagnosed as left hydronephrosis and UPJO. A ureteral stent had been placed 3 months before and failed to improve hydronephrosis, so the ureteral stent was pulled out. CT scan showed that left UPJ went through the two renal veins, suggesting UPJO. Nephrogram showed that left GFR and right GFR were 35 ml/min and 34 ml/min, respectively. These results indicated mechanical obstruction of left upper urinary tract. The patient underwent retroperitoneal laparoscopic Anderson-Hynes dismembered pyeloplasty. Results The surgical procedure was successful. Two left renal veins were found, and the ventral one was in front of ureter, compressing the ureter. An aberrant renal artery went into left kidney with the ureter. 0.5 cm stenosis of ureteropelvic junction was excised, and pyeloplasty was performed. A ureteral stent was placed into the ureter, then the pelvis and the ureter were sew up in front of the ventral renal vein. The surgical time was 240 rain, and blood loss was 50 ml. Postoperative hospital stay time was 4 d. During 4 months＇ fol- low up, hydronephrosis was attenuated significantly. Conclusion Retroperitoneal laparoseopic surgery for UPJO with aberrant two renal vein might be a minimally-invasive and effective procedure.
出处
《中华泌尿外科杂志》
CAS
CSCD
北大核心
2012年第11期818-821,共4页
Chinese Journal of Urology
