Szydełko Tomasz, Kopeć Roman, Kasprzak Jarosław, Apoznański Wojciech, Kołodziej Anna, Zdrojowy Romuald, Lorenz Jerzy
Department of Urology and Urological Oncology, Wrocław University of Medicine, Wrocław, Poland.
J Laparoendosc Adv Surg Tech A. 2009 Feb;19(1):45-51. doi: 10.1089/lap.2008.0104.
A retrospective study was performed to compare the results of laparoscopic pyeloplasty and antegrade endopyelotomy and complications observed after the two procedures.
Seventy-five endopyelotomies and 90 laparoscopic pyeloplasties in patients with primary ureteropelvic junction obstruction (UPJO) were performed. The diagnosis of UPJO was based on a complete medical history, ultrasonography, urography (IVU), and/or diuretic renography. In 52 cases, a Whitaker test was performed before endopyelotomy. The mean follow-up was 31 months in the endopyelotomy group and 28.5 months in the laparoscopy group. Complete success was defined as absence of any clinical symptoms combined with significant reduction of hydronephrosis on diuretic IVU and ultrasonography, and no sign of obstruction on diuretic IVU, diuretic renography, or Whitaker test.
Complete success was observed in 55.4% of patients after endopyelotomy and in 95.3% of patients after laparoscopic pyeloplasty. In patients with primary UPJO, laparoscopic procedures yield better therapeutic results than endopyelotomy, irrespective of the degree of hydronephrosis. The number of complications after the two procedures was comparable with the exception of intraoperative bleeding, which was more frequent in the case of endopyelotomy.
Laparoscopic pyeloplasty should be the procedure of choice in the treatment of primary UPJO.
进行一项回顾性研究,比较腹腔镜肾盂成形术和顺行肾盂内切开术的结果以及这两种手术后观察到的并发症。
对患有原发性输尿管肾盂连接部梗阻(UPJO)的患者进行了75例肾盂内切开术和90例腹腔镜肾盂成形术。UPJO的诊断基于完整的病史、超声检查、尿路造影(IVU)和/或利尿肾图。在52例病例中,在肾盂内切开术前进行了惠特克试验。肾盂内切开术组的平均随访时间为31个月,腹腔镜组为28.5个月。完全成功定义为无任何临床症状,同时利尿IVU和超声检查显示肾积水明显减轻,且利尿IVU、利尿肾图或惠特克试验无梗阻迹象。
肾盂内切开术后55.4%的患者和腹腔镜肾盂成形术后95.3%的患者观察到完全成功。在原发性UPJO患者中,无论肾积水程度如何,腹腔镜手术的治疗效果均优于肾盂内切开术。除术中出血外,两种手术后的并发症数量相当,术中出血在肾盂内切开术病例中更为常见。
腹腔镜肾盂成形术应是治疗原发性UPJO的首选手术。