摘要
目的：探讨后腹腔镜下离断式肾盂成形术治疗小儿肾盂输尿管连接部梗阻（ureteropelvic junc-tion obstruction,UPJO）的临床应用价值。方法：85例小儿UPJO患者中,男56例,女29例,年龄2.5~11岁,平均4.6岁。B超检查示：肾盂扩张积水〈15 mm（轻度）15例,15~30 mm（中度）59例,〉30 mm（重度）11例。静脉肾盂造影（intravenous urography,IVU）检查示：30 min内显影良好55例,30~120 min淡显影27例,120 min未显影3例。85例患者均行后腹腔镜下离断式肾盂成形术,术中采用传统顺行法或改良顺行法置入D-J管。结果：85例手术均获成功,无中转开放手术。平均手术时间146（125~240）min,平均出血量68（55~112）mL,术后平均住院时间7（6~8）d。1例术后发生尿漏,保持伤口引流通畅,1周后尿漏消失。85例患者均随访3~24月,平均11月。IVU显示肾盂输尿管连接部吻合口无狭窄,30 min内显影良好75例,30~120min淡显影10例。肾积水明显减轻,肾盂扩张积水消失51例,轻度积水25例,中度积水9例。结论：小儿后腹腔镜下离断式肾盂成形术安全、有效、微创,术后恢复快,可以作为治疗小儿UPJO的有效手术方法。
Objective To investigate the clinical application of retroperitoneoscopic dismembered pyeloplasty for pediatric ureteropelvic junction obstruction（UPJO）.Methods Of the 85 pediatric patients with UPJO,56 were boys and 29 were girls.The age of the patients ranged from 2.5 to 11 years（mean=4.6 years）.B-ultrasonography showed hydronephrosis 15 mm（mild） in 15 patients,15-30 mm（moderate） in 59,30 mm（severe） in the other 6.Intravenous urography（IVU） showed good imaging in 55 patients within 30 min,light imaging in 27 at 30-120 min,and no imaging in 3 after 120 min.The 85 patients underwent retroperitoneoscopic dismembered pyeloplasty.Conventional antegrade or modified antegrade double-J stenting was inserted in the 85 patients intraoperatively.Results The operation was successful in all,with no conversion to open surgery during the operation.The mean operation time was 146 min（125-240 min）.The mean blood loss was 68 mL（55-112 mL）.The mean postoperative hospitalization was 7 d（6-8 d）.Urine leakage occurred in 1 patient and with a good drainage,urine leakage disappeared in 1 week.Follow-up ranged 3-24 months（mean=11 months）.IVU showed on UPJ stricture,and good imaging in 75 patients within 30 min,light imaging in 10 at 30-120 min.Hydronephrosis was remitted：hydronephrosis resolution in 51 patients,mild in 6 and moderate in 3.Conclusion Retroperitoneoscopic dismembered pyeloplasty is a safe,effective and mini-invasive procedure for pediatric ureteropelvic junction obstruction,with a rapid postoperative recovery.It will be the ideal treatment for UPJO in pediatric patients.
出处
《中南大学学报（医学版）》
CAS
CSCD
北大核心
2011年第5期430-434,共5页
Journal of Central South University ：Medical Science
