Romero Frederico R, Wagner Andrew A, Trapp Claudemir, Permpongkosol Sompol, Muntener Michael, Link Richard E, Kavoussi Louis R
The James Buchanan Brady Urological Institute, The Johns Hopkins Medical Institutions, Baltimore, MD, USA.
J Urol. 2006 Dec;176(6 Pt 1):2526-9. doi: 10.1016/j.juro.2006.07.155.
Traditionally transperitoneal laparoscopic access to ureteropelvic junction obstruction has been performed in retrocolic fashion. We assessed transmesenteric laparoscopic pyeloplasty to correct ureteropelvic junction obstruction and compared results to those in patients undergoing traditional retrocolic laparoscopic pyeloplasty.
Between August 1999 and July 2005, 188 consecutive transperitoneal laparoscopic pyeloplasties were performed at our institution. A total of 18 patients underwent a transmesenteric approach and 170 underwent the classic retrocolic approach. Patient selection for the transmesenteric approach was at surgeon discretion with the inclusion criterion of recognition of the renal pelvis and/or ureter through the descending colonic mesentery.
Compared to patients undergoing traditional retrocolic procedure the transmesenteric approach was more commonly applied in younger individuals and males, and for pathological conditions on the left side and malrotated kidneys. The transmesenteric approach lowered operative time by a mean of 22.5% and decreased hospital stay by 19.2%. The patency success rate was 100% at a mean followup of 18.6 months for the transmesenteric approach and 94.1% at a mean followup of 22 months for the retrocolic approach.
In a select group of patients transmesenteric pyeloplasty may represent a more rapid alternative to the transperitoneal retrocolic approach and speed convalescence with similar success rates.
传统上，经腹腔腹腔镜治疗肾盂输尿管连接部梗阻采用结肠后入路。我们评估了经肠系膜腹腔镜肾盂成形术治疗肾盂输尿管连接部梗阻的效果，并将结果与接受传统结肠后腹腔镜肾盂成形术的患者进行比较。
1999年8月至2005年7月，我们机构连续进行了188例经腹腔腹腔镜肾盂成形术。共有18例患者采用经肠系膜入路，170例采用经典结肠后入路。经肠系膜入路的患者选择由外科医生决定，纳入标准是通过降结肠系膜能够识别肾盂和/或输尿管。
与接受传统结肠后手术的患者相比，经肠系膜入路在年轻个体、男性、左侧病理状况以及旋转不良肾脏中应用更为普遍。经肠系膜入路使手术时间平均缩短22.5%，住院时间缩短19.2%。经肠系膜入路平均随访18.6个月时通畅成功率为100%，结肠后入路平均随访22个月时通畅成功率为94.1%。
在特定患者群体中，经肠系膜肾盂成形术可能是经腹腔结肠后入路的一种更快的替代方法，能加快康复且成功率相似。
