后腹腔镜下离断式肾盂成形术.DOCVIP

临床医学论文-后腹腔镜下离断式肾盂成形术 ???????? 作者：王荣江，汪朔，邵四海，王伟高，钟欢，陈晓农，李辉，俞斌 【摘要】? 目的：探讨后腹腔镜离断式肾盂成形术的临床效果。方法：腹腔镜下通过后腹腔途径对肾盂输尿管连接部（UPJ）狭窄５例患者行离断式肾盂成形术。结果：５例手术均获成功，手术时间８０～１８０min，平均１１０min；术中出血量３０～９０ml，平均５０ml;漏尿１例；术后住院８～１５d，平均１０d。术后随访１～１２个月，ＵＰＪ吻合口无狭窄，肾积水改善。结论：后腹腔镜肾盂成形术微创，安全、效果好，值得推广。 　　【关键词】? 肾盂输尿管连接部梗阻；肾盂成形术；腹腔镜 　　【Abstract】? Ｏbjective:To investigate the clinical effect of retroperitoneal laparoscopic AndersonHynes dismembered pyeloplasty in the treatment of ureteropelvic junction(UPJ)obstruction.Methods:Retroperitoneal approach laparoscopic AndersonHynes dismembered pyeloplasty was performed in 5 cases with UPJ obstruction.Results:All operations were performed successfully.The mean operative time was 110 minutes(80１８０min),the mean blood loss was 50ml(3090ml).The mean postoperative hospitalization was 10 days(815days).Surgical complications included only 1 cases of urinary leakage.Followup a period of 1 to 12 months showed there was no stricture at UPJ hydronephrosis was remitted.Conclusions:Retroperitoneal laparoscopic AndersonHynes dismembered pyeloplasty has the advantages of minimal invasion,safe and high efficacy,which is worth further clinical application. 　　【Key words】? Ureteropelvic junction obstruction;Pyeloplasty;Laparoscopy ??? 肾盂输尿管连接部（ureteropelvic junction,UPJ)狭窄是引起肾盂积水及肾后性肾功能损害的常见原因之一。近年，腹腔镜技术在泌尿外科的应用范围日益广泛，采用此技术实施肾盂成形术受到了重视。２００４年１２月至２００６年１月我院采用后腹腔镜技术行离断式肾盂成形术治疗５例，疗效满意，现报道如下。 　　1? 资料与方法 　　11? 临床资料? 本组５例中男４例，女１例。６～５７岁，平均３１２岁。均为单侧，左侧３例，右侧２例，均有患侧腰部不同程度的酸胀史，约半月到１年，１例６岁患儿伴有血尿史。均行Ｂ超、排泄性尿路造影（ＩＶＵ）、磁共振水成像（ＭＲＵ）检查，１例逆行肾盂造影，患肾显影良好４例，显影差１例；肾积水轻度１例，中度３例，重度１例，均确诊为ＵＰＪ狭窄合并肾积水。 　　1２? 手术方法? 经腹膜后途径施术，全麻后取健侧卧位，腋中线髂嵴上约２cm做一２cm横行皮肤切口，用剪刀钝性分离肌层至腹膜后间隙，将自制水囊导管置入腹膜后间隙，充水约５００ml,维持３～５min后排水拔出水囊。手指引导下分别于腋前线、腋后线肋缘下置入５mm Trocar(左侧腋后线置入１０mm Trocar)，腋中线切口及腋前线平脐水平上分别放置１０mm Trocar。腋中线套管置入３０°腹腔镜。 　　超声刀纵行剪开肾周筋膜，首先分离肾下极内侧，显露并充分游离积水扩张的肾盂及输尿管上段，以明确狭窄部位和狭窄原因，根据扩张肾盂的特点，裁剪多余的肾盂，使肾盂口成漏斗状，在狭窄段远端约０５cm处离断输尿管，去除狭窄段输尿管，离断纤维束带和异行血管，施行AndersonHynes肾盂成形术。在输尿管壁近端外侧纵行剪开１～２cm，将输尿管近端与肾盂最低位用４０可吸收线全层端端缝合，先吻合后壁，放置双Ｊ管，再吻合前壁，最后连续缝