Fugita Oscar Eduardo, Jarrett Thomas W, Kavoussi Parviz, Kavoussi Louis R
James Buchanan Brady Urological Institute, Johns Hopkins Hospital, Baltimore, Maryland, USA.
J Endourol. 2002 Oct;16(8):571-4. doi: 10.1089/089277902320913251.
Retroperitoneal fibrosis (RPF) is an uncommon cause of ureteral obstruction. Surgical treatment is required in most cases. Open ureterolysis, although effective, is associated with significant morbidity and mortality rates. We present data on a series of 13 patients undergoing laparoscopic ureterolysis for RPF.
Between December 1994 and October 2000, 13 patients with RPF underwent laparoscopic ureterolysis at our institution. Operative time, complications, estimated intraoperative blood loss, time to oral intake, amount of parenteral analgesics used, and length of hospital stay were reviewed. Postoperative pyelography or diuretic urography was performed to assess ureteral patency.
Laparoscopic ureterolysis was successful in 11 patients (85%); two conversions to open surgery were needed (15%). One patient required a laparoscopic Boari flap on one side because of intense fibrosis. Four postoperative complications (30%) were managed with conservative measures. At a mean follow-up of 30 months, intravenous urography or renal scan showed relief of obstruction in 92% of the patients.
Laparoscopic ureterolysis is an option to treat RPF. It is not free of complications and failures, and its precise role in the treatment of RPF still needs to be judged with longer follow-up and larger number of patients.
腹膜后纤维化（RPF）是输尿管梗阻的一种罕见病因。大多数情况下需要进行手术治疗。开放输尿管松解术虽然有效，但与较高的发病率和死亡率相关。我们展示了一系列13例接受腹腔镜输尿管松解术治疗RPF患者的数据。
1994年12月至2000年10月期间，13例RPF患者在我院接受了腹腔镜输尿管松解术。回顾了手术时间、并发症、估计术中失血量、开始经口进食时间、使用的非肠道镇痛药用量以及住院时间。术后进行肾盂造影或利尿性尿路造影以评估输尿管通畅情况。
11例患者（85%）腹腔镜输尿管松解术成功；2例（15%）转为开放手术。1例患者因严重纤维化一侧需要行腹腔镜鲍里皮瓣术。4例术后并发症（30%）采用保守措施处理。平均随访30个月时，静脉尿路造影或肾扫描显示92%的患者梗阻缓解。
腹腔镜输尿管松解术是治疗RPF的一种选择。它并非没有并发症和失败情况，其在RPF治疗中的确切作用仍需要通过更长时间的随访和更多患者来判断。
