Gill Inderbir S, Cherullo Edward E, Steinberg Andrew P, Desai Mihir M, Abreu Sidney C, Ng Christopher, Kaouk Jihad H
Section of Laparoscopic and Minimally Invasive Surgery, Glickman Urological Institute, Cleveland Clinic Foundation, Cleveland, Ohio 44195, USA.
J Urol. 2004 Mar;171(3):1227-30. doi: 10.1097/01.ju.0000114233.66534.b0.
Ureterocalicostomy is a reconstructive option in the rare patient with surgically failed or difficult ureteropelvic junction (UPJ) obstruction with fibrosis and significant hydronephrosis. We introduce the technique of laparoscopic ureterocalicostomy.
Laparoscopic ureterocalicostomy was performed in 2 patients, of whom 1 had UPJ obstruction and multiple secondary calculi in a dilated, dependent lower pole calix, and 1 had surgically failed UPJ obstruction with a scarred pelvis and significant hydronephrosis. Using a transperitoneal technique the UPJ was dismembered and suture ligated, the cut end of the ureter was spatulated, the attenuated lower pole renal parenchyma was amputated and mucosa-to-mucosa ureterocaliceal anastomosis was performed with running 4-zero absorbable suture over a stent. In the first case 32 renal calculi were also removed using a combination of laparoscopic nephroscopy and intraoperative ultrasonography.
In cases 1 and 2 operative time was 5.2 and 2.5 hours, estimated blood loss was 200 and 75 cc, and hospital stay was 2 days, respectively. There were no intraoperative complications. The stent was removed at 8 and 5 weeks, respectively. Postoperative retrograde pyelogram and diuretic renal scan confirmed anastomotic patency and improved drainage in each patient. At 9 months patient 1 remains without flank symptoms and a second renal scan at 6 months showed further improvement in drainage. Patient 2, who continued to be symptomatic with flank discomfort despite objective improvement in drainage parameters, elected secondary nephrectomy at 6 months.
Laparoscopic ureterocalicostomy is feasible and it effectively duplicates established open surgical principles. To our knowledge the initial experience in the literature is presented.
输尿管肾盂吻合术是一种重建手术选择，适用于因纤维化和严重肾积水导致输尿管肾盂连接部（UPJ）梗阻手术失败或手术困难的罕见患者。我们介绍腹腔镜输尿管肾盂吻合术技术。
对2例患者实施了腹腔镜输尿管肾盂吻合术，其中1例为UPJ梗阻，扩张的、下垂的下极肾盏中有多个继发性结石，另1例为UPJ梗阻手术失败，肾盂瘢痕形成且有严重肾积水。采用经腹技术将UPJ离断并缝合结扎，输尿管断端做成斜面，切除变薄的下极肾实质，并在支架上用4-0可吸收缝线连续缝合进行黏膜对黏膜的输尿管肾盂吻合。在第一例中，还联合使用腹腔镜肾镜检查和术中超声检查取出了32颗肾结石。
病例1和病例2的手术时间分别为5.2小时和2.5小时，估计失血量分别为200毫升和75毫升，住院时间均为2天。术中无并发症。支架分别在8周和5周时取出。术后逆行肾盂造影和利尿肾扫描证实了每位患者吻合口通畅且引流改善。9个月时，病例1无胁腹症状，6个月时的第二次肾扫描显示引流进一步改善。病例2尽管引流参数客观上有所改善，但仍有胁腹不适症状，在6个月时选择了二期肾切除术。
腹腔镜输尿管肾盂吻合术是可行的，并且有效地复制了既定的开放手术原则。据我们所知，本文介绍了文献中的初步经验。
