Siqueira Tibrio M, Nadu Andrei, Kuo Ramsay L, Paterson Ryan F, Lingeman James E, Shalhav Arieh L
Department of Urology, Indiana University School of Medicine, Clarian Health Partners, Indianapolis, Indiana, USA.
Urology. 2002 Dec;60(6):973-8. doi: 10.1016/s0090-4295(02)02072-1.
To assess retrospectively the subjective and objective outcomes achieved after laparoscopic treatment for ureteropelvic junction obstruction at our institutions.
Between August 1999 and July 2001, 19 patients (11 women and 8 men), with a mean age of 31.2 years (range 17 to 67), underwent laparoscopic treatment for ureteropelvic junction obstruction. Of these, 17 patients were eligible for postoperative analysis. Nine of these patients had a history of prior surgical intervention on the affected side. The patients were subjectively assessed by an analog pain scale performed before and at least 6 months after surgery. Preoperatively, patients had a diuretic renal scan to confirm the presence of obstruction. Helical computed tomography was also performed preoperatively to assess for the presence of crossing vessels. The renal scan was repeated at least 12 weeks after surgery to document the relief of obstruction objectively.
Helical computed tomography correctly predicted the presence of crossing vessels in 12 patients (63%). The Anderson-Hynes and Fenger pyeloplasty techniques were performed in 16 and 2 patients, respectively. In 1 patient, a small crossing vein over the ureteropelvic junction was identified and divided without complications. The average operative time was 240 minutes (range 128 to 470). The blood loss was minimal, and no open conversions were required. The mean hospital stay was 2.9 days (range 2 to 7). Two postoperative complications occurred (11.7%). The average subjective follow-up was 14.4 months (range 6 to 27), and the average objective follow-up was 7.8 months (range 3 to 12). Of 17 assessable patients, 16 (94%) had subjective and objective success (postoperative improvement in analog pain score and half-life of radiotracer washout). The average split renal function improved from 34.1% to 38.5% (P <0.01).
On the basis of our data, laparoscopic pyeloplasty has a similar success rate compared with the traditional open approach and better results than other minimally invasive techniques. Longer follow-up and further experience are needed to validate these data.
回顾性评估我院行腹腔镜治疗肾盂输尿管连接部梗阻后的主观和客观疗效。
1999年8月至2001年7月，19例患者（11例女性，8例男性），平均年龄31.2岁（17至67岁），接受了腹腔镜治疗肾盂输尿管连接部梗阻。其中17例患者符合术后分析条件。这些患者中有9例患侧有既往手术干预史。术前及术后至少6个月采用视觉模拟疼痛量表对患者进行主观评估。术前，患者进行利尿肾图检查以确认梗阻的存在。术前还进行螺旋CT检查以评估是否存在交叉血管。术后至少12周重复肾图检查以客观记录梗阻的解除情况。
螺旋CT正确预测了12例患者（63%）存在交叉血管。分别有16例和2例患者采用了安德森-海因斯和芬格肾盂成形术。1例患者，在肾盂输尿管连接部上方发现一条小的交叉静脉并予以切断，无并发症发生。平均手术时间为240分钟（128至470分钟）。出血量极少，无需中转开放手术。平均住院时间为2.9天（2至7天）。发生了2例术后并发症（11.7%）。平均主观随访时间为14.4个月（6至27个月），平均客观随访时间为7.8个月（3至12个月）。17例可评估患者中，16例（94%）主观和客观疗效良好（术后视觉模拟疼痛评分改善及放射性示踪剂洗脱半衰期改善）。平均分肾功能从34.1%提高到38.5%（P<0.01）。
根据我们的数据，腹腔镜肾盂成形术与传统开放手术成功率相似，且比其他微创技术效果更好。需要更长时间的随访和更多经验来验证这些数据。
