Bernardo Norberto O, Rizzi Alfredo O, Prokopic Jorge, Mazza Osvaldo N
División de Urología, Hospital de Clínicas José de San Martín, Universidad de Buenos Aires, Argentina.
Arch Esp Urol. 2002 Jul-Aug;55(6):687-95.
The safety and success of antegrade endopyelotomy in the treatment of ureteropelvic junction (UPJ) stenosis have been documented in numerous literature reports over the last decade. We show a new available alternative to the way incision is performed.
Endopyelotomy with modified laparoscopic scissors was performed in 18 patients; 12 presented with primary obstruction and 6 with secondary obstruction. 3 mm laparoscopic scissors with one end sharpened and adapted for this technique are introduced through a nephroscope. A small puncture through the renal pelvis wall is made in the posterolateral position using the scissors' end. After that, scissors are opened under permanent endoscopic control as far as to visualization of the peripyelic space, continuing then with the internal edge of the scissors down to the UPJ. Visual control allowed us to coagulate any vessel and to avoid the bigger calibre ones. At the end of the procedure an endopyelotomy stent was placed over the safety guide wire.
Results were good in 17 patients (94%); symptomatic relief and adequate pass of contrast to proximal ureter were observed in the remaining case, although pyelocalicilar dilation was not improved. Three vessels adjacent to the UPJ (16.6%) were discovered through the performed pyelotomy incision. Operative times were lower than 2 hours. Blood losses were minimal and patient recovery uneventful allowing hospital discharges within 48 hours.
To use 3 mm laparoscopic scissors allows to perform endopyelotomy without changing endoscopes, precisely cutting due to retroperitoneum visualisation, and offers the chance to coagulate small calibre vascular elements and to avoid those of bigger size.
在过去十年中，众多文献报道记录了顺行肾盂内切开术治疗肾盂输尿管连接处（UPJ）狭窄的安全性和成功率。我们展示了一种新的切口操作替代方法。
对18例患者进行了使用改良腹腔镜剪刀的肾盂内切开术；其中12例为原发性梗阻，6例为继发性梗阻。将一端磨尖并适用于该技术的3毫米腹腔镜剪刀通过肾镜插入。使用剪刀尖端在肾盂壁后外侧位置做一个小穿刺。之后，在持续的内镜控制下打开剪刀，直至可见肾盂周围间隙，然后将剪刀的内边缘向下延伸至UPJ。视觉控制使我们能够凝固任何血管并避开较大口径的血管。手术结束时，在安全导丝上放置一个肾盂内切开术支架。
17例患者（94%）效果良好；在其余病例中观察到症状缓解且造影剂顺利通过至近端输尿管，尽管肾盂肾盏扩张未改善。通过所做的肾盂切开术切口发现了3条与UPJ相邻的血管（16.6%）。手术时间低于2小时。失血极少，患者恢复顺利，48小时内即可出院。
使用3毫米腹腔镜剪刀可在不更换内镜的情况下进行肾盂内切开术，由于可进行腹膜后可视化操作从而实现精确切割，并且有机会凝固小口径血管成分并避开较大口径的血管。
