Troxel Scott, Das Sakti, Helfer Eric, Nugyen Mike
Division of Urology, University of Missouri, 1 Hospital Drive, Columbia, MO 65212, USA.
J Urol. 2006 Sep;176(3):1073-6. doi: 10.1016/j.juro.2006.04.072.
Laparoscopic pyeloplasty offers similar success rates compared to open surgery. However, the advanced laparoscopic skills required may limit its widespread application. In select patients the dorsal lumbotomy approach can provide similar postoperative advantages to minimally invasive surgery. We analyze the perioperative management of laparoscopy vs dorsal lumbotomy for the repair of ureteropelvic junction obstruction.
In a retrospective review 13 patients who underwent dorsal lumbotomy pyeloplasty were compared to 19 patients who underwent laparoscopic pyeloplasty between 1998 and 2003. Preoperative confirmation of obstruction was obtained through excretory urogram or renal Lasix scan. All 13 patients undergoing dorsal lumbotomy had a dismembered pyeloplasty. Of the 19 laparoscopic cases 16 had a dismembered pyeloplasty and 3 had a Fenger procedure. Average followup was 12 months for the open group and 13.3 months for the laparoscopic group. Postoperative results were evaluated with excretory urogram or renal Lasix scan as well as subjective outcomes by the patients.
Operative time was slightly longer for the laparoscopy group at 231 minutes vs 200 minutes. Estimated blood loss and postoperative morphine requirements were also similar. Hospital stay was 3.3 days for the dorsal lumbotomy group compared to 2.4 for the laparoscopy group. The overall success rate for the laparoscopic group was 94.7% compared to 100% for the dorsal lumbotomy group. Each group had 1 complication, paresthesia of anterior/medial thigh that resolved by 6 months.
Our preliminary results show that a dismembered dorsal lumbotomy pyeloplasty is comparable to laparoscopic dismembered pyeloplasty with regard to intraoperative and postoperative hospital course.
与开放手术相比，腹腔镜肾盂成形术成功率相近。然而，所需的先进腹腔镜技术可能会限制其广泛应用。对于特定患者，背侧腰椎切开术可提供与微创手术相似的术后优势。我们分析了腹腔镜手术与背侧腰椎切开术修复肾盂输尿管连接部梗阻的围手术期管理。
回顾性分析1998年至2003年间接受背侧腰椎切开术肾盂成形术的13例患者，并与19例接受腹腔镜肾盂成形术的患者进行比较。通过排泄性尿路造影或肾脏速尿扫描进行术前梗阻确认。接受背侧腰椎切开术的13例患者均进行了离断性肾盂成形术。19例腹腔镜手术病例中，16例进行了离断性肾盂成形术，3例进行了芬格手术。开放手术组平均随访12个月，腹腔镜组平均随访13.3个月。通过排泄性尿路造影或肾脏速尿扫描以及患者的主观结果评估术后结果。
腹腔镜组手术时间稍长，为231分钟，而开放手术组为200分钟。估计失血量和术后吗啡需求量也相似。背侧腰椎切开术组住院时间为3.3天，腹腔镜组为2.4天。腹腔镜组总体成功率为94.7%，背侧腰椎切开术组为100%。每组各有1例并发症，即大腿前内侧感觉异常，6个月后缓解。
我们的初步结果表明，离断性背侧腰椎切开术肾盂成形术在手术中和术后住院过程方面与腹腔镜离断性肾盂成形术相当。
