Rassweiler Jens J, Subotic Svetozar, Feist-Schwenk Michaela, Sugiono Marto, Schulze Michael, Teber Dogu, Frede Thomas
Department of Urology, SLK Kliniken Heilbronn, University of Heidelberg, Heidelberg, Germany.
J Urol. 2007 Mar;177(3):1000-5. doi: 10.1016/j.juro.2006.10.049.
First line treatment of ureteropelvic junction obstruction is still open dismembered pyeloplasty. The development of videoendoscopic techniques like endopyelotomy and laparoscopy offers less invasive alternatives. The long-term outcome of an algorithm selectively using these techniques is presented.
From February 1995 to March 2006, 256 patients with ureteropelvic junction obstruction were treated with 113 laser endopyelotomies and 143 laparoscopic retroperitoneal pyeloplasties. According to changing selection criteria, an early group (92 in 1995 to 1999) treated with laser endopyelotomy for extrinsic as well as intrinsic stenoses, and a late group (164 in 2000 to 2006) treated with laser endopyelotomy for intrinsic stenosis, were evaluated. In the late group extrinsic ureteropelvic junction obstruction was treated with nondismembered pyeloplasty in cases of anteriorly and by dismembered pyeloplasty in cases of posteriorly crossing vessels or a redundant renal pelvis.
Operating time of laser endopyelotomy averaged 34 (range 10 to 90) minutes with a complication rate of 5.3% and a success rate of 72.6% (intrinsic 85.7% vs extrinsic 51.4%). Operating time of laparoscopic retroperitoneal pyeloplasty averaged 124 (range 37 to 368) minutes with a 6.3% complication rate and an overall success rate of 94.4% (intrinsic 100% vs extrinsic 93.8%). In the late group the LAP success rate was 98.3% with no significant differences related to the cause of ureteropelvic junction obstruction (intrinsic 100% vs extrinsic 98.1%) or the type of pyeloplasty (YV plasty 97.0% vs Anderson-Hynes 97.7%).
Laparoscopic retroperitoneal pyeloplasty yields an efficacy similar to that of open surgery. The inferior success of laser endopyelotomy even in optimally selected cases and the increasing expertise with endoscopic suturing may favor laparoscopic pyeloplasty with or without robotic assistance in the future.
肾盂输尿管连接部梗阻的一线治疗方法仍是开放性离断性肾盂成形术。诸如内镜肾盂切开术和腹腔镜手术等视频内镜技术的发展提供了侵入性较小的替代方法。本文介绍了一种选择性应用这些技术的算法的长期结果。
1995年2月至2006年3月，256例肾盂输尿管连接部梗阻患者接受了113例激光内镜肾盂切开术和143例腹腔镜腹膜后肾盂成形术治疗。根据不断变化的选择标准，对早期组（1995年至1999年的92例）和晚期组（2000年至2006年的164例）进行了评估，早期组采用激光内镜肾盂切开术治疗外在性和内在性狭窄，晚期组采用激光内镜肾盂切开术治疗内在性狭窄。在晚期组中，外在性肾盂输尿管连接部梗阻在前侧病例中采用非离断性肾盂成形术治疗，在后侧血管交叉或肾盂积水病例中采用离断性肾盂成形术治疗。
激光内镜肾盂切开术的平均手术时间为34（10至90）分钟，并发症发生率为5.3%，成功率为72.6%（内在性狭窄为85.7%，外在性狭窄为51.4%）。腹腔镜腹膜后肾盂成形术的平均手术时间为124（37至368）分钟，并发症发生率为6.3%，总体成功率为94.4%（内在性狭窄为100%，外在性狭窄为93.8%）。在晚期组中，腹腔镜手术成功率为98.3%，与肾盂输尿管连接部梗阻的病因（内在性狭窄为100%，外在性狭窄为98.1%）或肾盂成形术类型（Y-V成形术为97.0%，安德森-海因斯成形术为97.7%）无关，无显著差异。
腹腔镜腹膜后肾盂成形术的疗效与开放手术相似。即使在最佳选择的病例中，激光内镜肾盂切开术的成功率较低，且内镜缝合技术的专业知识不断增加，这可能有利于未来在有或没有机器人辅助的情况下进行腹腔镜肾盂成形术。
