后腹腔镜离断性肾盂成形术治疗肾盂输尿管连接部梗阻临床研究和手术新进展.doc

后腹腔镜离断性肾盂成形术治疗肾盂输尿管连接部梗阻临床研究和手术新进展 　　【摘要】 目的：探讨腹膜后腹腔镜离断性肾盂成形术治疗输尿管连接部梗阻（UPJO）的理论基础、手术技巧、临床效果及UPJO手术新进展。方法：回顾性分析经后腹腔镜肾盂成形术治疗的46例UPJO患者的临床资料。结果：手术时间75～400 min，平均186 min；术中出血量5～30 ml，平均20 ml；术后住院时间6～20 d，平均7.5 d。围手术期尿漏2例，1例因术后吻合口出血导致，1例因术后护理不当夹闭尿管造成，均保守治疗治愈。45例术后随访肾积水及肾功能均得到改善，1例患者因肾积水加重再次行开放性肾盂成形术。结论：经后腹腹腔镜下离断性肾盂成形术治疗初发UPJO具有安全、成功率高、无腹腔并发症等优点，可以进一步的推广和应用。后腹腔镜肾盂成形术能否用于第二次肾盂输尿管连接部梗阻的患者还需要进一步的探索。 【关键词】 肾盂输尿管连接部梗阻； 腹腔镜； 肾盂成形术； 手术新进展 Clinical Analysis of Retroperitoneal Laparoscopic Dismembered Pyeloplasty for Ureteropelvic Junction Obstruction and Surgery New Progress/WANG Ying-lei， MENG Lin， XIAO Lin， et al.//Medical Innovation of China，2013，10（15）：024-026 【Abstract】 Objective： To study theoretical basis， operation techniques and clinical effect for ureteropelvic junction obstruction by retroperitoneal laparoscopic dismembered pyeloplasty and to study surgery new progress of UPJO. Method： The clinical data of 46 patients with UPJO who underwent retroperitoneal laparoscopic pyeloplasty were retrospectively analyzed. Result： The mean operating time was 186 minutes（range from 75 to 400）， the mean blood loss was 20 ml（range from 5 to 30）， and the mean postoperative hospitalization days were 7.5 days（range from 6 to 20）. Postoperative follow-up of hydronephrosis and renal function were improved. In peri operation period， two cases presented with urinary leakage， one because of postoperative anastomotic stoma bleeding， another improper nursing of closing catheter， two cases were cured by conservative treatment. 45 operations had been successful， hydronephrosis of one male patient was aggravated， which was operated by open pyeloplasty. Conclusion： Retroperitoneal laparoscopic pyeloplasty for primary UPJO has the advantages of security， high success rate and no abdominal complications etc， and can be further promotion and application. Whether retroperitoneal laparoscopic pyeloplasty can be used for the second UPJO also needs further exploration. 【Key words】 Ureterope