Chen Zhi, Chen Xiang, Qi Lin, Chen Liang, Luo Yancheng, He Yao, Li Nannan, Xie Chaoqun
Department of Urology, Xiangya Hospital, Central South University, Changsha 410008, China.
Zhong Nan Da Xue Xue Bao Yi Xue Ban. 2011 May;36(5):430-4. doi: 10.3969/j.issn.1672-7347.2011.05.010.
To investigate the clinical application of retroperitoneoscopic dismembered pyeloplasty for pediatric ureteropelvic junction obstruction (UPJO).
Of the 85 pediatric patients with UPJO, 56 were boys and 29 were girls. The age of the patients ranged from 2.5 to 11 years (mean = 4.6 years).B-ultrasonography showed hydronephrosis <15 mm (mild) in 15 patients,15-30 mm (moderate) in 59, <30 mm (severe) in the other 6. Intravenous urography (IVU) showed good imaging in 55 patients within 30 min, light imaging in 27 at 30-120 min, and no imaging in 3 after 120 min. The 85 patients underwent retroperitoneoscopic dismembered pyeloplasty. Conventional antegrade or modified antegrade double-J stenting was inserted in the 85 patients intraoperatively.
The operation was successful in all, with no conversion to open surgery during the operation. The mean operation time was 146 min (125-240 min).The mean blood loss was 68 mL (55-112 mL).The mean postoperative hospitalization was 7 d (6-8 d ).Urine leakage occurred in 1 patient and with a good drainage, urine leakage disappeared in 1 week. Follow-up ranged 3-24 months (mean = 11 months).IVU showed on UPJ stricture, and good imaging in 75 patients within 30 min, light imaging in 10 at 30-120 min. Hydronephrosis was remitted:hydronephrosis resolution in 51 patients, mild in 6 and moderate in 3.
Retroperitoneoscopic dismembered pyeloplasty is a safe, effective and mini-invasive procedure for pediatric ureteropelvic junction obstruction, with a rapid postoperative recovery. It will be the ideal treatment for UPJO in pediatric patients.
探讨后腹腔镜离断性肾盂成形术在小儿肾盂输尿管连接部梗阻（UPJO）中的临床应用。
85例小儿UPJO患者中，男56例，女29例。年龄2.5～11岁（平均4.6岁）。B超显示肾盂积水＜15mm（轻度）15例，15～30mm（中度）59例，＞30mm（重度）6例。静脉肾盂造影（IVU）显示30min内显影良好55例，30～120min显影淡27例，120min后仍未显影3例。85例均行后腹腔镜离断性肾盂成形术，术中85例均常规行顺行或改良顺行双J管置入。
手术均获成功，术中无中转开放手术者。平均手术时间146min（125～240min），平均出血量68ml（55～112ml），术后平均住院时间7d（6～8d）。1例出现尿漏，经充分引流，1周后尿漏消失。随访3～24个月（平均11个月）。IVU显示肾盂输尿管连接部狭窄解除，30min内显影良好75例，30～120min显影淡10例。肾盂积水缓解情况：积水消失51例，轻度6例，中度3例。
后腹腔镜离断性肾盂成形术治疗小儿肾盂输尿管连接部梗阻安全、有效、微创，术后恢复快，是小儿UPJO的理想治疗方法。
