Calvert R C, Morsy M M, Zelhof B, Rhodes M, Burgess N A
Department of Urology, Norfolk and Norwich University Hospital NHS Trust, Colney Lane, Norwich, Norfolk, NR4 7UY, UK.
Surg Endosc. 2008 Feb;22(2):411-4. doi: 10.1007/s00464-007-9436-0.
This study aimed to determine whether the morbidity and outcome rates for laparoscopic transperitoneal dismembered pyeloplasty are different from those for dismembered pyeloplasty, to analyze the learning curve of laparoscopic pyeloplasty, and to determine whether preoperative stent placement affects outcome.
For this study, 49 laparoscopic pyeloplasties (period 2000-2005) and 51 open pyeloplasties (period 1992-2003) were reviewed.
Compared with open procedures, laparoscopic procedures were associated with a longer mean operating time (159 vs 91 min; p < 0.001), a shorter mean time to normal diet (38 vs 72 h; p < 0.001), and a similar mean hospital stay (5 days; p = 0.6). The operative complication rates were 17% for primary laparoscopic pyeloplasties and 24% for primary open pyeloplasties. The rates were higher for secondary procedures. The success rates for primary and secondary procedures were, respectively, 98% (41/42) and 57% (4/7) for laparoscopy and 96% (46/48) and 67% (2/3) for open surgery. Failed procedures showed no improvement in loin pain or obstruction. At the 6-month follow-up evaluation, 29% of the open surgery patients but none of the laparoscopic surgery patients reported wound pain.
The efficacy of laparoscopic pyeloplasty is equivalent to that of open pyeloplasty, with less wound pain at 6 months. The outcome for secondary procedures is inferior. There was a trend toward a reduction in complications and the conversion rates with time, suggesting that there may be a learning curve of approximately 30 laparoscopic pyeloplasty cases. Preoperative stent insertion did not seem to affect any objective measures of outcome for laparoscopic pyeloplasty.
本研究旨在确定腹腔镜经腹膜肾盂成形术的发病率和结局率是否与开放性肾盂成形术不同，分析腹腔镜肾盂成形术的学习曲线，并确定术前放置支架是否会影响结局。
本研究回顾了49例腹腔镜肾盂成形术（2000 - 2005年）和51例开放性肾盂成形术（1992 - 2003年）。
与开放性手术相比，腹腔镜手术的平均手术时间更长（159分钟对91分钟；p < 0.001），恢复正常饮食的平均时间更短（38小时对72小时；p < 0.001），平均住院时间相似（5天；p = 0.6）。初次腹腔镜肾盂成形术的手术并发症发生率为17%，初次开放性肾盂成形术为24%。二次手术的发生率更高。腹腔镜手术初次和二次手术的成功率分别为98%（41/42）和57%（4/7），开放性手术分别为96%（46/48）和67%（2/3）。手术失败的患者腰部疼痛或梗阻无改善。在6个月的随访评估中，29%的开放性手术患者报告有伤口疼痛，而腹腔镜手术患者均未报告。
腹腔镜肾盂成形术的疗效与开放性肾盂成形术相当，6个月时伤口疼痛较轻。二次手术的结局较差。随着时间推移，并发症和中转率有下降趋势，表明腹腔镜肾盂成形术可能存在约30例的学习曲线。术前放置支架似乎不影响腹腔镜肾盂成形术结局的任何客观指标。
