Department of Urology, First People's Hospital affiliated to Shanghai Jiao Tong University, Shanghai, China.
Chin Med J (Engl). 2009 Nov 20;122(22):2728-32.
Laparoscopic dismembered pyeloplasty is technically feasible for ureteropelvic junction (UPJ) obstruction although it is still challenged by its technical difficulty and time-consuming. In this study, we compared the initial results of retroperitoneal laparoscopic pyeloplasty versus a combined laparoscopic dissection and open reconstruction through a small incision in the treatment of UPJ obstruction.
Sixty-four patients with primary UPJ obstruction underwent pyeloplasty: 32 patients underwent laparoscopic procedure and 32 patients underwent open assisted laparoscopic surgery including two steps, ie, laparoscopic dissection of the UPJ transperitoneally and then pyeloplasty via an extended small incision. The demographic data and intraoperative, postoperative and follow-up conditions of patients were compared between the two groups.
Preoperative data were comparable in the patients of the two groups. The operative time was shorter (60.9 minutes vs 157.7 minutes, P < 0.0001) and the complication rate was lower (9.4% vs 31.3%, P < 0.05) in the open assisted group than in the laparoscopic group. The estimated blood loss (42.3 ml vs 47.8 ml), time to have normal diet (37.6 hours vs 33.8 hours), and hospital stay (6.7 days vs 6.2 days) were equivalent. The operative success rate was 97% for the open assisted group and 91% for the laparoscopic group.
The procedure of combined small incision with laparoscopy for UPJ obstruction is technically easy, and the results are promising. It can be used as an alternative to conventional procedures.
腹腔镜离断肾盂成形术治疗肾盂输尿管连接部（UPJ）梗阻在技术上是可行的，但仍存在技术难度大和耗时的挑战。在本研究中，我们比较了后腹腔镜肾盂成形术与经小切口联合腹腔镜解剖和开放重建治疗 UPJ 梗阻的初始结果。
64 例原发性 UPJ 梗阻患者接受肾盂成形术：32 例行腹腔镜手术，32 例行开放辅助腹腔镜手术，包括两步，即经腹膜外腹腔镜解剖 UPJ，然后通过延长小切口行肾盂成形术。比较两组患者的一般资料、术中、术后和随访情况。
两组患者的术前资料无差异。开放辅助组的手术时间更短（60.9 分钟比 157.7 分钟，P<0.0001），并发症发生率更低（9.4%比 31.3%，P<0.05）。两组患者的估计出血量（42.3ml 比 47.8ml）、恢复正常饮食时间（37.6 小时比 33.8 小时）和住院时间（6.7 天比 6.2 天）相似。开放辅助组手术成功率为 97%，腹腔镜组为 91%。
经小切口联合腹腔镜治疗 UPJ 梗阻的方法技术简单，效果令人满意。它可以作为传统方法的替代选择。
