Türk Ingolf A, Davis John W, Winkelmann Björn, Deger Serdar, Richter Frank, Fabrizio Michael D, Schönberger Bernd, Jordan Gerald H, Loening Stefan A
Department of Urology, Charite Hospital School of the Humboldt University, Schumannstrasse 20-21, 10117, Berlin, Germany.
Eur Urol. 2002 Sep;42(3):268-75. doi: 10.1016/s0302-2838(02)00315-9.
Herein we report our experience of 49 consecutive pyeloplasties that were all laparoscopically performed with an intracorporeally sutured anastomosis. We describe the operative technique, complications and outcomes during a follow-up period of 1-53 months (mean 23.2 months).
Forty-nine patients (28 women and 21 men) with a mean age of 34 years (range 6-65 years) underwent a laparoscopic dismembered pyeloplasty because of primary ureteropelvic junction (UPJ) obstruction with hydronephrosis in each case. The preoperative evaluation included an evaluation for pain, an excretory urography (IVP), renal scan and sometimes CT angiography to evaluate for crossing vessels. Follow-up studies included an IVP, renal scan and renal ultrasound 4 weeks postoperatively and every 3 months thereafter. Success was considered as improvement of the pain score and IVP (less hydronephrosis, visible UPJ and/or normalization of drainage) or absence of an obstructive pattern during the washout phase of a renal scan.
There was no conversion to open surgery. The mean operative time was 165 min (range 90-240 min). Blood loss was negligible. Crossing vessels were noted in 57.1% of the patients (28/49). Postoperative hospital stay was 3.7 days (range 3-6 days). One patient had a leakage of the anastomosis on postoperative day 1 and needed to undergo laparoscopic repair. The mean follow-up is 23.2 months (range 1-53 months). There was one single late failure. This patient later underwent an open revision of the laparoscopic pyeloplasty. In all other patients (48/49), the obstruction was resolved or significantly improved. The long-term success rate is 97.7%.
The results of dismembered laparoscopic pyeloplasties compare favorably with those achieved by open pyeloplasties with less perioperative morbidity and discomfort. We do believe that laparoscopic dismembered pyeloplasty with an intracorporeal anastomosis is the method of choice in the treatment of the UPJ obstruction in the presence of an enlarged renal pelvis and crossing vessels.
在此我们报告连续49例均通过腹腔镜进行体内缝合吻合的肾盂成形术的经验。我们描述了手术技术、并发症以及1至53个月（平均23.2个月）随访期内的结果。
49例患者（28例女性和21例男性），平均年龄34岁（范围6至65岁），因原发性输尿管肾盂连接部（UPJ）梗阻伴肾积水，均接受了腹腔镜离断性肾盂成形术。术前评估包括疼痛评估、排泄性尿路造影（IVP）、肾脏扫描，有时还包括CT血管造影以评估交叉血管情况。术后随访研究包括术后4周及此后每3个月进行一次IVP、肾脏扫描和肾脏超声检查。成功定义为疼痛评分和IVP改善（肾积水减轻、可见UPJ和/或引流正常化）或肾脏扫描冲洗期无梗阻表现。
无转为开放手术的情况。平均手术时间为165分钟（范围90至240分钟）。失血可忽略不计。57.1%的患者（28/49）发现有交叉血管。术后住院时间为3.7天（范围3至6天）。1例患者术后第1天吻合口漏，需接受腹腔镜修复。平均随访时间为23.2个月（范围1至53个月）。有1例出现晚期失败。该患者后来接受了腹腔镜肾盂成形术的开放修复术。在所有其他患者（48/49）中，梗阻得到解决或明显改善。长期成功率为97.7%。
离断性腹腔镜肾盂成形术的结果与开放肾盂成形术相比具有优势，围手术期发病率和不适更少。我们确实认为，对于存在肾盂扩大和交叉血管的UPJ梗阻，采用体内吻合的腹腔镜离断性肾盂成形术是首选治疗方法。
