Boylu Ugur, Lee Benjamin R, Thomas Raju
Department of Urology, Tulane University School of Medicine, New Orleans, Louisiana, USA.
J Laparoendosc Adv Surg Tech A. 2009 Jun;19(3):379-82. doi: 10.1089/lap.2008.0297.
A 22-year-old female was referred with right flank pain and recurrent urinary infections. Flank pain was persistent while standing and relieved upon supine position. Intravenous urography demonstrated change of position with descent approximately 6-7 cm as the patient moved from the supine to the erect position. Diuretic renography corroborated the finding of right ureteropelvic junction obstruction (UPJO). A robotic-assisted laparoscopic dismembered pyeloplasty with simultaneous nephropexy was performed. The proximal ureter appeared to course posterior to the renal vein and then anterior to the lower pole renal artery. There was a significant "nutcracker effect" to the proximal ureter, which was causing the patient's UPJO, and the concomitant nephroptosis contributed to increase the degree of obstruction. The robotic-assisted laparoscopic pyeloplasty and nephropexy offer advantages for patients and surgeons and can be used in challenging cases with an efficacy similar to that of open repair. The robotic-assisted laparoscopic pyeloplasty is the evolving standard for UPJO, especially in the presence of crossing vessels.
一名22岁女性因右侧腰痛和反复尿路感染前来就诊。站立时腰痛持续存在，仰卧位时缓解。静脉肾盂造影显示，当患者从仰卧位变为直立位时，肾脏位置下降约6 - 7厘米。利尿肾图证实了右侧肾盂输尿管连接处梗阻（UPJO）的诊断。遂行机器人辅助腹腔镜离断性肾盂成形术并同期肾固定术。近端输尿管走行于肾静脉后方，然后在下极肾动脉前方。近端输尿管存在明显的“胡桃夹效应”，这是导致患者UPJO的原因，同时并存的肾下垂加重了梗阻程度。机器人辅助腹腔镜肾盂成形术和肾固定术对患者和外科医生都有优势，可用于具有挑战性的病例，其疗效与开放修复相似。机器人辅助腹腔镜肾盂成形术正在成为治疗UPJO的标准术式，尤其是在存在交叉血管的情况下。
