摘要
目的:探讨经腹腔途径腹腔镜下离断式肾盂成形术治疗肾盂输尿管连接部梗阻(UPJO)的临床效果。方法:采用经腹腔途径腹腔镜下离断式肾盂成形术治疗UPJO患者42例,男25例,女17例,平均年龄30(12～50)岁。其中左侧24例,右侧18例;重度肾积水17例,中度肾积水22例,轻度肾积水3例。结果:42例手术均顺利完成,无中转开放手术者。其中3例伴肾盂结石者同时取出肾盂结石;5例迷走血管为梗阻原因者,将受压段输尿管切除后于血管腹侧吻合。平均手术时间110(80～200)min,平均术中出血量25(10～50)ml。术后漏尿2例,分别于术后7天及40天消失,其余患者术后4～5天拔出引流管,6～7天拔出导尿管;术前表现为腰腹部胀痛者术后症状减轻或消失,术后平均住院时间8(6～11)d。术后4～6周拔出双J管,未见特殊不适。40例随访3～36个月,行彩超及IVU等影像学检查,2例患侧UPJ吻合口狭窄伴肾积水,行输尿管镜下丝状电极内切开术后治愈;余38例中,肾积水消失15例,肾积水减轻18例,肾积水无加重5例。结论:经腹腹腔镜下离断式肾盂成形术视野清晰,易于缝合,创伤小,恢复快,是治疗UPJO较为理想的手术方法。
Objective：To explore the clinical value of transperitoneal laparoscopic dismembered pyeloplasty for ureteropelvic junction obstruction（UPJO）. Methods：The clinical data of 42 cases with UPJO were respectively reviewed. Among the cases, 25cases were male and 17 cases were female. Their ages ranged from 12 to 50 years old. The diagnosis was set up by color ultrasonography and IVU and MRU. All the cases had hydroneprosis, with 3 cases mild, 22 cases moderate, 17 cases severe. 42 patients with UPJO underwent transperitoneal laparoscopic dismembered pyeloplasty. Results： All the operations were performed successfully, without conversions to open surgery. The average operation time was 110 minutes, the average blood lose was 25 ml, and the postoperative hospital stay was 8 days. 2 cases occurred urinary leakage and recovered 7 days and 40 days later respectively. 40 cases were followed-up for 3 to 36 months, examined by color ultrasonography and IVU. 2 case occurred ureteral stenosis and cured by ureteroscopic needle electrode. Hydroneprosis disappeared in 15 cases, decreased in 18 cases, stabilized in 5 cases. Conclusions：Transperitoneal laparoscopic dismembered pyeloplasty could be a mini-invasive, effective, and easy operating procedure for the treatment of UPJO.
出处
《临床泌尿外科杂志》
2013年第3期209-211,共3页
Journal of Clinical Urology
