Zhou Li-qun, Zhang Zhong-yi, Li Xue-song, He Zhi-song
Department of Urology, Peking University First Hospital, National Urological Cancer Center, Beijing 100034, China.
Beijing Da Xue Xue Bao Yi Xue Ban. 2011 Aug 18;43(4):540-3.
To discuss the feasibility and safety of laparoscopic transperitoneal and transmesenteric pyeloplasty for recurrent ureteropelvic junction obstruction (UPJO).
From May 2006 to June 2008, we admitted 5 cases of recurrent UPJO who had received open retroperitoneal pyeloplasty with 3 males and 2 females. They were 19 to 32 years old with the average of 24.5 years and suffered from recurrent UPJO 3 to 16 years with the average of 7.8 years after operation. They felt discomfort in the lumbar region to different extent and their intravenous pyelography (IVP) or computerized tomography for urinary system (CTU) showed typical UPJO. The nucleotide renal scan (NRS) revealed that the renal excretion was slow, even after intravenous injection of diuretics. The laparoscopic transperitoneal and transmesenteric pathway was done in such a way that the incision was longitudinal at the mesentery of small intestine near the affected ureteropelvic junction (UPJ). The UPJ was isolated to avoid injuring the intestine and the mesenteric blood vessels. The UPJO was removed with the routine Anderson-Hynes technique and the anastomosis between pelvis and ureter was carried out by 2 separate and running sutures.
The operating time was 105-230 min with the average of 165 min and the estimated blood loss was 50 to 120 mL with the average of 75 mL. Patients left bed on the first day and the drainage tube was taken out on the 4th to 5th day after the operation. There were no other injuries and complications. By October of 2008, they had been followed up for 33 to 49 months with the average of 37.5 months and IVP or CTU and the diuretic NRS showed smooth excretion of the operated UPJ.
As for experienced hands, the laparoscopic transperitoneal and transmesenteric pyeloplasty is feasible and safe for recurrent UPJO, but it's not recommended to the beginners of laparoscopic procedures.
探讨腹腔镜经腹腔及经肠系膜肾盂成形术治疗复发性肾盂输尿管连接部梗阻（UPJO）的可行性及安全性。
2006年5月至2008年6月，收治5例复发性UPJO患者，其中男性3例，女性2例。年龄19至32岁，平均24.5岁，术后复发性UPJO病程3至16年，平均7.8年。患者均有不同程度的腰部不适，静脉肾盂造影（IVP）或泌尿系统计算机断层扫描（CTU）显示典型的UPJO。核素肾扫描（NRS）显示即使静脉注射利尿剂后，肾脏排泄仍缓慢。腹腔镜经腹腔及经肠系膜入路的操作方法为：在患侧肾盂输尿管连接部（UPJ）附近的小肠系膜处做纵行切口。游离UPJ以避免损伤肠管及肠系膜血管。采用常规Anderson-Hynes技术切除UPJO，肾盂与输尿管之间的吻合采用2根间断连续缝合。
手术时间为105至230分钟，平均165分钟；估计失血量为50至120毫升，平均75毫升。患者术后第1天即可下床活动，术后第4至5天拔除引流管。无其他损伤及并发症。至2008年10月，随访33至49个月，平均37.5个月，IVP或CTU及利尿NRS显示手术侧UPJ排泄通畅。
对于有经验的术者，腹腔镜经腹腔及经肠系膜肾盂成形术治疗复发性UPJO是可行且安全的，但不建议腹腔镜手术初学者采用。
