Porpiglia Francesco, Billia Michele, Volpe Alessandro, Morra Ivano, Scarpa Roberto M
Department of Urology, University of Turin, San Luigi Hospital, Orbassano, Turin, Italy.
BJU Int. 2008 Apr;101(8):1024-8. doi: 10.1111/j.1464-410X.2007.07323.x. Epub 2007 Dec 7.
To describe and evaluate the safety and outcome of transperitoneal left laparoscopic pyeloplasty (TLLP) with a direct approach to the pelvi-ureteric junction (PUJ) through the mesentero-colic space, which avoids mobilization of the descending colon.
From March 2005 to June 2006, 18 consecutive patients underwent TLLP with direct access. For each patient age, gender, body mass index (BMI), hospital stay, skin-to-skin operative time, time from incision of the posterior peritoneum to dissection of the PUJ, blood loss, time to resumption of oral intake and complications were recorded. Statistical analysis was used to assess whether the body habitus (BMI <25 kg/m(2) or >25 kg/m(2)) affected the outcomes.
There were no complications during or after surgery and no conversions to open surgery were needed. The mean (SD) time to resumption of oral intake was 1.36 (0.5) days. The mean hospital stay was 3.3 (0.67) days and the mean follow-up was 17.4 (4.7) months. There was no statistical difference between patients with BMI higher or lower than 25 kg/m(2) (P = 0.42). The success rate at 1 year after surgery was 100%.
TLLP with direct access to the PUJ through the mesentero-colic space is a safe and effective technique. This approach should be considered for all patients with left primary PUJ obstruction who are eligible for a LP and especially for slim patients or patients with a large renal pelvis.
描述并评估经腹膜左腹腔镜肾盂成形术（TLLP），该手术通过肠系膜结肠间隙直接进入肾盂输尿管连接部（PUJ），避免了降结肠的游离。
2005年3月至2006年6月，18例连续患者接受了直接入路的TLLP。记录每位患者的年龄、性别、体重指数（BMI）、住院时间、皮肤到皮肤的手术时间、从后腹膜切开到PUJ分离的时间、失血量、恢复经口进食的时间以及并发症。采用统计分析评估身体状况（BMI<25kg/m²或>25kg/m²）是否影响手术结果。
手术期间及术后均无并发症，无需转为开放手术。恢复经口进食的平均（标准差）时间为1.36（0.5）天。平均住院时间为3.3（0.67）天，平均随访时间为17.4（4.7）个月。BMI高于或低于25kg/m²的患者之间无统计学差异（P = 0.42）。术后1年成功率为100%。
通过肠系膜结肠间隙直接进入PUJ的TLLP是一种安全有效的技术。对于所有符合腹腔镜肾盂成形术条件的左侧原发性PUJ梗阻患者，尤其是体型瘦的患者或肾盂较大的患者，应考虑采用这种方法。
