后腹腔镜肾盂成形术治疗少儿UPJO临床价值.docVIP

后腹腔镜肾盂成形术治疗少儿UPJO临床价值 　　摘 要 目的:探讨后腹腔镜肾盂成形术治疗少儿肾盂输尿管连接部梗阻(UPJO)的适应证、手术技巧及临床应用价值。方法:回顾性分析经后腹腔镜治疗的16例UPJO患者的临床资料。结果:16例手术均获成功。手术时间120～200分钟,平均155分钟;出血量50～110ml,平均75ml。术后平均住院时间8?5天(6～11天)。围手术期无并发症。随访6～18个月,UPJ吻合口无狭窄、肾积水,肾功能均得到改善。结论:后腹腔镜肾盂成形术是治疗少儿UPJO有效、微创、安全、术后恢复快、住院时间短的一种手术方法,可望做为少儿UPJO治疗的首选手术方法,值得临床推广。 　　关键词 肾盂输尿管连接部梗阻 后腹腔镜 　　doi:10.3969/j.issn.1007-614x.2010.13.049? 　　AbstractObjective:To evaluate the choice of indications and clinical effects of retroperitoneoscopic pyeloplasty for ureteropelvic junction obstruction(UPJO)in children,and to review its technical details.Methods:Clinical data of 16 casespatients with UPJO treated by the post-laparoscopicwere retrospectively analysed.Results:Retroperitoneoscopicy pyeloplast was performed successfully in all 16 cases.The operative time ranged from 120 to 200min(mean,155min).The blood loss ranged from 50 to110ml(mean,75ml).The mean postoperative hospital stay was 8.5d(range,6～11d).There was no perioperative complication.During the follow-up of 6～18 months,no anastomotic stoma stricture of UPJ developed;hydronephrosis resolved and renal function improved.Conclusion:Retroperitoneal pyeloplasty is mini-invasive,reliable,safe,faster recover from operation,shorter hospitolized days for the treatment of UPJO.It may be used as the first choice for treatment of UPJO in children and extremely deserve the clinical expansion. 　　Key WordsUreteropelvic junction obstruction;Retroperitoneal pyeloplast 　　资料与方法 　　 2003年5月～2009年6月收治肾盂输尿管连接部梗阻(UPJO)患者16例,男9例,女7例;年龄7～14岁,平均11岁;左侧8例,右侧8例。患者均有患侧腰部疼痛史3个月～2年,平均6个月。所有患者均行B超证实有肾积水,肾盂轻度扩张积水(30mm)5例。KUB+IVP检查显影良好14例,2例不显影,经逆行造影证实为UPJO。术中证实2例系肾脏下极迷走血管压迫所致。合并肾盂结石1例。均无肾输尿管手术史。 　　 手术方法:16例患者均采用全麻,健侧卧位,抬高腰??充分延伸肋弓与髂嵴之间的距离。三孔法建立腹膜后通道[1]:注入CO?2,气体压力维持在10～15cmH?2O(1cmH?2O=0?098kPa)。由Trocar分别置入操作器械。常规清理腹膜后脂肪,显露腹膜后解剖标志。超声刀纵行剪开肾周筋膜和脂肪囊,在肾脏背侧下级紧贴肾实质表面分离肾盂和输尿管上段,充分暴露扩张的肾盂,明确狭窄部位和原因。1例并发结石者,先行肾盂切开取石。1例有迷走血管压迫,试阻断,无肾供血障碍,予以切断。根据扩张肾盂的特点,弧形裁剪多余的肾盂,使肾盂口成喇叭状,在狭窄段远端约0?5cm离断输尿管,祛除狭窄段输尿管,在输尿管壁近端外侧纵行剪开1cm,用5-0薇桥缝