Bansal Punit, Gupta Aman, Mongha Ritesh, Narayan Srinivas, Das Ranjit K, Bera Malay, Chakraborty Sudip C, Kundu Anup K
IPGMER &SSKM HOSPITAL, 329, Doctors Hostel, 242, AJC Bose Road, Kolkata, 700020 India.
Indian J Surg. 2011 Aug;73(4):264-7. doi: 10.1007/s12262-011-0237-2. Epub 2011 Apr 26.
UPJO causes hydronephrosis and progressive renal impairment may ensue if left uncorrected. Open pyeloplasty remains the standard against which new technique must be compared. We analyzed the comparison of Laparoscopic and open pyeloplasty in a randomized prospective trial. A prospective randomized study was done from January 2004 to January 2007 in which a total of 28 Laparoscopic and 34 open pyeloplasty were done. All laparoscopic pyeloplasties were performed transperitoneally. Standard open Anderson Hynes pyeloplasty, spiral flap or VY plasty was done depending on anatomic consideration. Patients were followed with DTPA scan at 3 months and IVP at 6 months. Perioperative parameters including operative time, analgesic use, hospital stay, and complication and success rates were compared. Mean total operative time with stent placement in LP group was 244.2 min (188-300 min) compared to 122 min (100-140 min) in open group. Compared to open pyeloplasty the post operative diclofenac requirement was significantly less in LP group (mean107.14 mg) and open group required mean of (682.35 mg) The duration of analgesic requirement was also significantly less in LP group. The post operative hospital stay in LP was mean 8.29 days (7-11) and was significantly less than open group (mean 3.14 Days (2-7 days). Open pyeloplasty has been the gold standard for UPJO repair and achieves success rates exceeding 90%. Laparoscopic pyeloplasty provides a minimally invasive alternative to repair UPJO and has developed world wide as the first minimally option to match success rate of open pyeloplasty. Its potential advantages including less post op pain, shorter hospital stay an improved cosmesis has been proved in some comparative series. The only disadvantage seems to be longer operative time. LP has a minimal level of morbidity and short hospital stay compared to open approach Although Laparoscopic pyeloplasty has the disadvantages of longer operative time and requires significant skill of intracorporeal knotting but it is here to stay and represents an emerging standard of care.
肾盂输尿管连接部梗阻（UPJO）可导致肾积水，若不纠正，可能会出现进行性肾功能损害。开放性肾盂成形术仍然是新技术必须与之比较的标准。我们在一项随机前瞻性试验中分析了腹腔镜肾盂成形术与开放性肾盂成形术的比较。2004年1月至2007年1月进行了一项前瞻性随机研究，共进行了28例腹腔镜肾盂成形术和34例开放性肾盂成形术。所有腹腔镜肾盂成形术均经腹腔进行。根据解剖情况进行标准的开放性安德森·海因斯肾盂成形术、螺旋瓣成形术或V-Y成形术。患者在术后3个月进行二巯基丁二酸（DTPA）扫描，6个月进行静脉肾盂造影（IVP）检查。比较围手术期参数，包括手术时间、镇痛药使用情况、住院时间以及并发症和成功率。腹腔镜肾盂成形术（LP）组放置支架后的平均总手术时间为244.2分钟（188 - 300分钟），而开放性手术组为122分钟（100 - 140分钟）。与开放性肾盂成形术相比，LP组术后双氯芬酸的需求量显著更少（平均107.14毫克），开放性手术组平均需求量为（682.35毫克）。LP组镇痛药的使用时间也显著更短。LP组术后平均住院时间为8.29天（7 - 11天），明显少于开放性手术组（平均3.14天（2 - 7天））。开放性肾盂成形术一直是治疗UPJO的金标准，成功率超过90%。腹腔镜肾盂成形术为修复UPJO提供了一种微创替代方法，并且在全球范围内已发展成为第一种成功率与开放性肾盂成形术相当的微创选择。在一些比较研究系列中已证明其潜在优势包括术后疼痛减轻、住院时间缩短和美容效果改善。唯一的缺点似乎是手术时间较长。与开放性手术相比，LP的发病率极低且住院时间短。虽然腹腔镜肾盂成形术有手术时间长和需要较高体内打结技巧的缺点，但它已成为一种既定的治疗方式，并代表了一种新兴的治疗标准。
