Lam John S, Cooper Kimberly L, Greene Tricia D, Gupta Mantu
Department of Urology, New York-Presbyterian Hospital, Columbia University College of Physicians and Surgeons, New York, New York 10032, USA.
Urology. 2003 Jun;61(6):1107-11; discussion 1111-2. doi: 10.1016/s0090-4295(03)00231-0.
To compare, in a single-surgeon, single-institution study, the efficacy of antegrade and retrograde endopyelotomy in terms of success rate and morbidity and to identify which risk factors affect treatment outcomes.
The results were retrospectively reviewed for 88 patients with ureteropelvic junction obstruction treated with endopyelotomy. Antegrade endopyelotomy was performed with a hook knife, scissors, or cutting balloon device. Retrograde endopyelotomy was performed with a cutting balloon device. Objective results were based on intravenous urogram and/or diuretic nuclear renal scan findings, and subjective results were based on direct patient query and questionnaire.
Ninety-three endopyelotomy procedures, 64 antegrade and 29 retrograde, were performed. The mean follow-up was 37.0 months (range 5 to 76). The overall success rates between antegrade and retrograde endopyelotomy (81.3% versus 75.9%) were not statistically different (P = 0.553). Patients with massive hydronephrosis and poor initial renal function were less likely to have successful endopyelotomy. Antegrade endopyelotomy, however, was more successful than retrograde endopyelotomy in patients with massive hydronephrosis (66.7% versus 20.0%; P = 0.046). The average operative time for antegrade and retrograde endopyelotomy was 93.9 and 32.7 minutes (P <0.001), respectively. The average length of hospital stay after antegrade and retrograde endopyelotomy was 3.20 and 0.14 nights (P <0.001), respectively.
Both antegrade and retrograde endopyelotomy are effective treatments for ureteropelvic junction obstruction associated with minimal morbidity. Antegrade endopyelotomy appears to be more successful in patients with high-grade hydronephrosis. Retrograde endopyelotomy results in a shorter hospital stay, a shorter operative time, and less postoperative pain.
在一项单术者、单机构研究中，比较顺行性和逆行性肾盂内切开术在成功率和发病率方面的疗效，并确定哪些危险因素会影响治疗结果。
回顾性分析88例行肾盂内切开术治疗输尿管肾盂连接部梗阻患者的结果。顺行性肾盂内切开术采用钩形刀、剪刀或切割球囊装置进行。逆行性肾盂内切开术采用切割球囊装置进行。客观结果基于静脉肾盂造影和/或利尿肾动态扫描结果，主观结果基于直接询问患者和问卷调查。
共进行了93例肾盂内切开术，其中顺行性64例，逆行性29例。平均随访时间为37.0个月（范围5至76个月）。顺行性和逆行性肾盂内切开术的总体成功率（81.3%对75.9%）无统计学差异（P = 0.553）。重度肾积水和初始肾功能较差的患者肾盂内切开术成功的可能性较小。然而，在重度肾积水患者中，顺行性肾盂内切开术比逆行性肾盂内切开术更成功（66.7%对20.0%；P = 0.046）。顺行性和逆行性肾盂内切开术的平均手术时间分别为93.9分钟和32.7分钟（P <0.001）。顺行性和逆行性肾盂内切开术后的平均住院时间分别为3.20晚和0.14晚（P <0.001）。
顺行性和逆行性肾盂内切开术都是治疗输尿管肾盂连接部梗阻的有效方法，发病率极低。顺行性肾盂内切开术在重度肾积水患者中似乎更成功。逆行性肾盂内切开术可缩短住院时间、缩短手术时间并减轻术后疼痛。
