Douenias R, Smith A D, Brock W A
Department of Urology, Long Island Jewish Medical Center, New Hyde Park, New York.
Urol Clin North Am. 1990 May;17(2):419-28.
In conclusion, endopyelotomy has been developed over the past several decades on the basis of sound laboratory and clinical research. The success rates have been similar to those of the standard open pyeloplasty, and the procedure is not associated with undue complications. Endopyelotomy has several distinct advantages over open surgery, including the decreased morbidity and associated expense of an open operation, minimal interference with the blood supply of the ureter, and avoidance of removal of the ureter from its natural sheath, preventing the tendency to adhere to adjacent structures and thus kink. As the instrumentation available for percutaneous renal surgery has improved and been miniaturized, the techniques developed in adults have been progressively applied to younger and smaller children. There seems to be little doubt that a comparison of morbidity and socioeconomic factors associated with a successful endopyelotomy versus an open pyeloplasty in adults heavily favors the percutaneous procedures, and judicious application to children would seem warranted. However, the changing presentation of ureteropelvic junction obstruction in children that has resulted from the widespread use of prenatal ultrasonography may make the question moot. Open infant pyeloplasty is a highly successful procedure, accompanied by minimal morbidity and accomplished in a 2- to 3-day hospital stay. The socioeconomic factors are obviated in the infant, who already requires constant maternal care. However, endopyelotomy deserves consideration in the older child, especially if the obstruction is secondary in nature after a previous open procedure.
总之，在过去几十年中，肾盂内切开术是在扎实的实验室和临床研究基础上发展起来的。其成功率与标准开放性肾盂成形术相似，且该手术不会引发过多并发症。与开放性手术相比，肾盂内切开术有几个明显优势，包括开放性手术发病率和相关费用降低、对输尿管血液供应干扰最小，以及避免将输尿管从其天然鞘膜中分离，防止输尿管粘连至相邻结构并因此扭结。随着可用于经皮肾手术的器械不断改进并小型化，在成人中开发的技术已逐渐应用于年龄更小、体型更小的儿童。毫无疑问，在成人中，成功的肾盂内切开术与开放性肾盂成形术相比，在发病率和社会经济因素方面，经皮手术具有明显优势，因此明智地应用于儿童似乎是合理的。然而，由于产前超声检查的广泛应用，儿童输尿管肾盂连接部梗阻的表现发生了变化，这可能使这个问题变得没有实际意义。开放性婴儿肾盂成形术是一种非常成功的手术，发病率极低，住院2至3天即可完成。对于已经需要母亲持续照料的婴儿来说，社会经济因素并不重要。然而，对于年龄较大的儿童，尤其是先前开放性手术后梗阻为继发性的情况，肾盂内切开术值得考虑。
