Castillo O A, Cabrera W, Aleman E, Vidal-Mora I, Yañez R
Departamento de Urología y Centro de Cirugía Robótica, Clínica INDISA, Santiago, Chile; Facultad de Medicina, Universidad Andrés Bello, Santiago, Chile.
Departamento de Urología y Centro de Cirugía Robótica, Clínica INDISA, Santiago, Chile.
Actas Urol Esp. 2014 Mar;38(2):103-8. doi: 10.1016/j.acuro.2013.04.010. Epub 2013 Aug 1.
To present our long-term results with the Anderson-Hynes laparoscopic pyeloplasty, performed by a single surgeon.
Between August 1999 and December 2009, 79 patients (80 procedures) were operated for primary ureteropelvic junction obstruction. We use the Anderson-Hynes technique by a transperitoneal approach. Patients were evaluated with Ultrasound, Excretory urography and dynamic renal scintigraphy (Mag-3). The perioperative characteristics, complications and results were reviewed.
We performed 80 laparoscopic pyeloplasties in 79 patients. Mean operative time was 93.2 minutes (60-180). Crossing vessels were found in 38 of 82 (46.3%) renal units. Kidney abnormalities occurred in 4 patients (1 double ureteropelvic system, one associated retrocaval ureter, 1 horseshoe kidney and one pelvic kidney). Complications occurred in 5 procedures (6.5%): an immediately postoperative bleeding (Clavien 3b), 1 cecal volvulus (Clavien 3b), 1 urosepsis (Clavien 4th) and 1 urinary fistula (Clavien 3a). In this series there was neither mortality nor conversion to open surgery There was recurrence in 3 out of 80 patients (3.7%). They were resolved as follows: 1 percutaneous antegrade endopyelotomy, 1 secondary laparoscopic pyeloplasty and 1 robotic pyeloplasty. There was a 96.3%. of primary overall success rate.
Our results show that laparoscopic pyeloplasty compares favorably with the result achieved by open surgery. We believe that laparoscopic pyeloplasty is a good surgical alternative for the management of primary ureteropelvic junction obstruction.
介绍由单一外科医生实施的安德森-海恩斯腹腔镜肾盂成形术的长期结果。
1999年8月至2009年12月期间，79例患者（80例手术）因原发性输尿管肾盂连接部梗阻接受手术。我们采用经腹途径的安德森-海恩斯技术。患者接受超声、排泄性尿路造影和动态肾闪烁显像（Mag-3）评估。回顾围手术期特征、并发症及结果。
我们对79例患者实施了80例腹腔镜肾盂成形术。平均手术时间为93.2分钟（60 - 180分钟）。82个肾单位中的38个（46.3%）发现有交叉血管。4例患者出现肾脏异常（1例双输尿管肾盂系统、1例合并腔静脉后输尿管、1例马蹄肾和1例盆腔肾）。5例手术（6.5%）出现并发症：1例术后即刻出血（Clavien 3b级）、1例盲肠扭转（Clavien 3b级）、1例尿脓毒症（Clavien 4级）和1例尿瘘（Clavien 3a级）。本系列中无死亡病例，也未转为开放手术。80例患者中有3例（3.7%）复发。复发情况如下：1例行经皮顺行肾盂内切开术、1例行二次腹腔镜肾盂成形术和1例行机器人肾盂成形术。总体初次成功率为96.3%。
我们的结果表明，腹腔镜肾盂成形术与开放手术的效果相比具有优势。我们认为腹腔镜肾盂成形术是治疗原发性输尿管肾盂连接部梗阻的一种良好手术选择。
