Zhang Xu, Xu Kai, Fu Bin, Zhang Jun, Lang Bin, Ai Xing, Wang Baojun, Shi Taoping, Ma Xin
Departments of Urology, Tongji Hospital, Tongji Medical College, Huazhong, University of Science and Technology, Wuhan, China.
BJU Int. 2007 Dec;100(6):1335-8. doi: 10.1111/j.1464-410X.2007.07131.x. Epub 2007 Sep 10.
To report our experience with the treatment of pelvi-ureteric junction obstruction (PUJO) using the retroperitoneal laparoscopic Hellström (RLH) technique to relocate the crossing vessel.
We used the RLH technique selectively in eight patients with PUJO from an aberrant crossing vessel, according to observations during surgery. The crossing vessel was mobilized and embedded in the generous pelvic wall with 4-0 polyglactin sutures to relieve the PUJO. Follow-up studies included intravenous urography, ultrasonography and renal functional scintigraphy at 1 month after surgery and every 3 months thereafter.
The mean (range) operative duration was 45 (40-60) min; the blood loss was negligible. Crossing vessels were identified to be anterior to the renal pelvis in two patients and posterior in six. The hospital stay after surgery was 5 (4-7) days. No paregoric was required after surgery. The collecting systems were intact and no JJ stent was required in any patient. The mean (range) follow-up was 13.6 (12-15) months. In all patients the obstruction was resolved or significantly improved, and there were no complications, e.g. urine leakage and infection. A long-term follow-up is mandatory.
The RLH technique is a minimally invasive alternative for patients with PUJO caused by a crossing vessel. Embedding the crossing vessels in the pelvic wall is feasible and safe for such patients; empirical judgement during surgery is prudent for success.
报告我们使用腹膜后腹腔镜赫尔斯特伦（RLH）技术重新定位交叉血管治疗肾盂输尿管连接部梗阻（PUJO）的经验。
根据手术中的观察，我们对8例因异常交叉血管导致PUJO的患者选择性地使用了RLH技术。游离交叉血管并用4-0聚乙醇酸缝线将其埋入宽大的盆腔壁以缓解PUJO。随访研究包括术后1个月及此后每3个月进行静脉肾盂造影、超声检查和肾功能闪烁扫描。
平均（范围）手术时间为45（40 - 60）分钟；失血可忽略不计。2例患者交叉血管位于肾盂前方，6例位于后方。术后住院时间为5（4 - 7）天。术后无需使用止痛剂。所有患者的集合系统均完整，无需放置双J支架。平均（范围）随访时间为13.6（12 - 15）个月。所有患者的梗阻均得到缓解或显著改善，且无尿漏、感染等并发症。长期随访是必要的。
RLH技术是治疗由交叉血管引起的PUJO患者的一种微创替代方法。对于此类患者，将交叉血管埋入盆腔壁是可行且安全的；手术中的经验判断对成功至关重要。
