后腹腔镜肾盂成形术技术改进

发布时间：2018-04-15 06:06

本文选题：后腹腔 + 腹腔镜　；参考：《中国微创外科杂志》2016年10期

【摘要】：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。
[Abstract]:Objective to introduce an improved laparoscopic pyeloplasty and evaluate its effect.Methods from April 2007 to January 2016, 110 patients with ureteropelvic junction obstruction underwent laparoscopic pyeloplasty.After suture and fixation of the lower pelvis and ureter, the renal pelvis were cut; the posterior wall of the pelvis and the posterior wall of the ureter were sutured continuously from the bottom up; after the stent was placed, the anterior wall of the renal pelvis was sutured continuously from the top to the bottom.The operative results of 23 cases in the improved group and 87 cases in the traditional group were retrospectively compared.Results compared with the traditional group, the operation time of the improved group was shorter [183.6 卤47.5)min vs.(221.3 卤63.7 mintbum -3.129 P0. 003] there was no significant difference in the incidence of urinary leakage after operation between the two groups.In the improved group, 21 cases were followed up for 7.1 卤3.1 months, 13 cases of hydronephrosis disappeared, 8 cases of relief, and 54 cases of traditional group were followed up for 49.5 卤23.2 months, 25 cases of hydronephrosis disappeared, 22 cases were relieved, and 3 cases of aggravation (secondary operation).Conclusion the improved retroperitoneal pyeloplasty is easier to operate and shorter, which may have better effect, but it still needs to increase the sample size and prolong the follow-up.
【作者单位】：北京大学第三医院泌尿外科;
【分类号】：R699.2

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