A Modified Retroperitoneal Laparoscopic Pyeloplasty

目的：介绍一种改进后腹腔镜肾盂成形术，评估其手术效果。方法2007年4月～2016年1月，对肾盂输尿管连接部梗阻110例行腹腔镜肾盂成形术。2014年10月后23例采用改进的方法，包括：先不将肾盂和输尿管完全离断，在肾盂下角与输尿管缝合固定后再裁剪肾盂；肾盂后壁与输尿管后壁使用自下而上的间断缝合；放置支架管后，肾盂前壁采用一针自上而下的连续缝合。回顾性比较改进组23例与传统组87例的手术结果。结果与传统组比较，改进组手术时间短[（183．6±47．5）min vs．（221．3±63．7）min， t＝－3．129， P＝0．003]，2组中转开放手术、术后尿漏发生率差异无统计学意义。改进组21例随访（7．1±3．1）月，肾积水消失13例，减轻8例，无需要二次手术者；传统组54例随访（49．5±23．2）月，肾积水消失25例，减轻22例，无变化3例，4例加重（行二次手术）。结论改进后的后腹腔镜肾盂成形术操作更加容易，手术时间更短，可能具有更好的效果，但仍需要进一步增加样本量和延长随访。Objective To describe and evaluate a modified technique of retroperitoneal laparoscopic pyeloplasty for ureteropelvic junction obstruction ( UPJO) . Methods A retrospective analysis was performed in 110 consecutive cases of UPJO , who underwent retroperitoneal laparoscopic pyeloplasty in our institution between April 2007 and January 2016.A modified technique was applied in 23 cases after October 2014.In the modified technique operation , firstly we partially cut the pelvis and ureter to keep the connecting before plasty and suture .Then bottom-up interupted suture of posterior wall and top-down running suture of anterior wall of the renal pelvis and ureter were carried out .Data of the modified technique were retrospectively compared with the other 87 cases of original technique . Results As compared with the original technique , the modified technique required shorter operative time [(183.6 ±47.5) min vs.(221.3 ±63.7) min, t=-3.129, P=0.003].There was no statistical difference in open conversion rate and urinary leakage between the two groups .In the modified technique group , the mean follow-up time was (7.1 ±3.1) months in 21 cases.Hydronephrosis disappeared in 13 cases and relieved in 8 cases.There was no conversion or urinary leakage .While in the original technique group, the mean follow-up time was (49.5 ±23.2) months in 54 cases.Hydronephrosis disappeared in 25 cases and relieved in 22 cases.There were no changes in 3 cases and reoperations were performed in 4 cases. Conclusions This modified retroperitoneal laparoscopic pyeloplasty is feasible and seems to allow shorter operation time and higher success rate .However, sizable samples and further analysis of modified technique need to be completed in the future .中文核心期刊要目总览(PKU)中国科技核心期刊(ISTIC)中国科学引文数据库(CSCD)10903-906,9101