Seo Ill Young, Oh Tae Hoon, Lee Jae Whan
Department of Urology, Institute of Wonkwang Medical Science, Wonkwang University School of Medicine, Iksan, Korea.
Korean J Urol. 2014 Oct;55(10):656-9. doi: 10.4111/kju.2014.55.10.656. Epub 2014 Oct 10.
To assess the long-term follow-up results of laparoscopic pyeloplasty for ureteropelvic junction obstruction.
Sixty-five patients (mean age, 43.8 years) who underwent standard laparoscopic pyeloplasty by transperitoneal approaches were enrolled in this study. The chief complaint was flank pain (n=57 patients); the remaining cases were detected incidentally. Twenty-three patients had undergone previous abdominal surgeries, including open pyeloplasty and endopyelotomy. Mean stricture length was 1.06 cm. Grade 3/4 and 4/4 hydronephrosis was detected in 36 and 14 patients, respectively. An obstructive pattern was present on the renal scan in 53 patients (81.5%).
Fifty-seven patients were treated with dismembered Anderson-Hynes pyeloplasty and eight patients with Fenger pyeloplasty. During the operation, crossing vessels were found in 27 patients (41.5%). Mean operating time was 159.42 minutes. Although there were no cases of open conversion, two patients with colon and spleen injuries were detected postoperatively. The mean starting time of postoperative ambulation and diet was 1.54 days and 1.86 days, respectively. Mean hospital stay was 8.09 days. Mean follow-up period was 36.5 months. Follow-up intravenous pyelography and renal scan showed improvements in 59 patients, and the radiologic success rate was 90.8%. Eight patients showed failure on radiologic or symptomatic evaluation, and the overall success rate was 87.7%. In the comparative analysis between the success and failure groups, drained amount was the only risk factor related to failure (554.41 mL. vs. 947.70 mL, p=0.024).
Long-term follow-up results support laparoscopic pyeloplasty as the standard treatment for ureteropelvic junction obstruction. Drained amount is a risk factor for failure of the operation.
评估腹腔镜肾盂成形术治疗肾盂输尿管连接部梗阻的长期随访结果。
本研究纳入65例经腹膜途径行标准腹腔镜肾盂成形术的患者（平均年龄43.8岁）。主要症状为胁腹痛（57例患者）；其余病例为偶然发现。23例患者曾接受过腹部手术，包括开放性肾盂成形术和肾盂内切开术。平均狭窄长度为1.06 cm。分别在36例和14例患者中检测到3/4级和4/4级肾积水。53例患者（81.5%）的肾扫描显示存在梗阻模式。
57例患者接受了离断性安德森-海因斯肾盂成形术，8例患者接受了芬格肾盂成形术。手术过程中，27例患者（41.5%）发现有交叉血管。平均手术时间为159.42分钟。虽然没有转为开放手术的病例，但术后发现2例患者有结肠和脾脏损伤。术后平均开始活动和进食时间分别为1.54天和1.86天。平均住院时间为8.09天。平均随访期为36.5个月。随访静脉肾盂造影和肾扫描显示59例患者病情改善，影像学成功率为90.8%。8例患者在影像学或症状评估中显示失败，总体成功率为87.7%。在成功组和失败组的比较分析中，引流量是与失败相关的唯一危险因素（554.41 mL对947.70 mL，p = 0.024）。
长期随访结果支持腹腔镜肾盂成形术作为肾盂输尿管连接部梗阻的标准治疗方法。引流量是手术失败的危险因素。
