肾盂内切开术与腹腔镜肾盂成形术治疗输尿管肾盂连接部梗阻致肾功能不佳肾脏的比较

Comparison of endopyelotomy and laparoscopic pyeloplasty for poorly functioning kidneys with ureteropelvic junction obstruction.

作者信息

Singh Pratipal, Kapoor Rakesh, Suri Amit, Singh Kamal Jeet, Mandhani Anil, Dubey Deepak, Srivastava Aneesh, Kumar Anant

机构信息

Department of Urology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India.

出版信息

Indian J Urol. 2007 Jan;23(1):9-12. doi: 10.4103/0970-1591.30255.

DOI:10.4103/0970-1591.30255

PMID:19675751

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC2721514/

Abstract

UNLABELLED

Endopyelotomy and laparoscopic pyeloplasty are established procedures for ureteropelvic junction obstruction (UPJO) and historically a high failure rate has been observed in poorly functioning units with UPJ obstruction. The aim of this study is to compare the results of laparoscopic pyeloplasty with endopyelotomy in poorly functioning renal units, i.e., GFR under 25 ml/min.

MATERIALS AND METHODS

Retrospective analysis of all the patients who underwent either laparoscopic pyeloplasty or endopyelotomy for ureteropelvic junction obstruction in poorly functioning units between January 1998 and June 2005 was done. Follow-up renal scans, done at three, six, 12 months and yearly thereafter, were studied. Success was defined as symptomatic relief and/ or improvement in function (10% over baseline) in renal scan.

RESULTS

There were 23 patients in the endopyelotomy group and 15 patients in the laparoscopic pyeloplasty group with mean age of 25.3 years (9-53) and 26 years (10-44), respectively. Mean pelvic volume was 41.2 8cc +/- 9.5 and 39.1cc +/- 9.85 in the endopyelotomy group and laparoscopic pyeloplasty group, respectively. Mean preoperative GFR was 17.4 +/- 5.7 ml/min and 21 +/- 4.5 ml/min in the endopyelotomy group and laparoscopic pyeloplasty group, respectively and mean postoperative GFR was 21 +/- 3.5 ml/min and 22 +/- 3.9 ml/min, respectively. Eighteen and 11 patients were symptomatic in ethe ndopyelotomy group and laparoscopic pyeloplasty group, respectively while symptomatic improvement was seen in 14 and 11 patients, respectively. Mean follow-up was 12 months in the laparoscopy group and 28 months in the endopyelotomy group. Success rate was better for laparoscopic surgery group (15/15 = 100%) than for endopyelotomy (18/23 = 78.26%).

CONCLUSIONS

Though the improvement in renal function is less in patients with UPJO with poorly functioning kidneys undergoing endopyelotomy or laparoscopic pyeloplasty, laparoscopic pyeloplasty gives better results in the form of symptomatic relief; however, renal function remains stable whichever the approach chosen.

摘要

未标注

肾盂内切开术和腹腔镜肾盂成形术是治疗肾盂输尿管连接部梗阻（UPJO）的既定手术方法，从历史上看，在功能不佳的肾盂输尿管连接部梗阻单位中观察到较高的失败率。本研究的目的是比较腹腔镜肾盂成形术与肾盂内切开术在肾功能不佳的单位（即肾小球滤过率低于25毫升/分钟）中的治疗结果。

材料与方法

对1998年1月至2005年6月期间在功能不佳的单位接受腹腔镜肾盂成形术或肾盂内切开术治疗肾盂输尿管连接部梗阻的所有患者进行回顾性分析。研究了在术后3个月、6个月、12个月及之后每年进行的随访肾脏扫描。成功定义为症状缓解和/或肾脏扫描中功能改善（比基线提高10%）。

结果

肾盂内切开术组有23例患者，腹腔镜肾盂成形术组有15例患者，平均年龄分别为25.3岁（9 - 53岁）和26岁（10 - 44岁）。肾盂内切开术组和腹腔镜肾盂成形术组的平均肾盂容积分别为41.28立方厘米±9.5立方厘米和39.1立方厘米±9.85立方厘米。肾盂内切开术组和腹腔镜肾盂成形术组的术前平均肾小球滤过率分别为17.4±5.7毫升/分钟和21±4.5毫升/分钟，术后平均肾小球滤过率分别为21±3.5毫升/分钟和22±3.9毫升/分钟。肾盂内切开术组和腹腔镜肾盂成形术组分别有18例和11例患者有症状，而分别有14例和11例患者症状改善。腹腔镜组的平均随访时间为12个月，肾盂内切开术组为28个月。腹腔镜手术组的成功率（15/15 = 100%）高于肾盂内切开术组（18/23 = 78.26%）。