Nishi Morihiro, Tsuchida Mayumi, Ikeda Masaomi, Matsuda Daisuke, Iwamura Masatsugu
Department of Urology, Kitasato University School of Medicine, Sagamihara, Kanagawa, Japan.
Int J Urol. 2015 Apr;22(4):368-71. doi: 10.1111/iju.12686. Epub 2015 Jan 19.
To evaluate the long-term results of laparoscopic pyeloplasty in patients with secondary ureteropelvic junction obstruction after failed primary interventions.
Between August 2000 and October 2012, transperitoneal dismembered laparoscopic pyeloplasty was carried out in 13 patients with a surgical history of failed prior surgical interventions. Perioperative outcomes as well as long-term results were assessed. These outcomes were compared with those of the same procedure carried out for primary ureteropelvic junction obstruction by a single surgeon during the same study period.
Laparoscopic transperitoneal pyeloplasty was completed successfully in all cases without converting to open surgery or requiring blood transfusion. The preoperative symptoms in 12 of 13 patients all disappeared soon after the operation. Asymptomatic severe hydronephrosis found in a 2-year-old boy reduced in size postoperatively. When comparing the primary with the secondary laparoscopic pyeloplasty carried out by the same surgeon, the mean operative time was longer (183 vs 241 min, P = 0.002), estimated blood loss was larger (33 vs 66 mL, P = 0.03) and the complication rate was higher (8.8% vs 22.2%, P = 0.01) in the secondary group. Success rates were 97.9% and 100% (P = 0.41) at a mean follow up of 25.9 and 40.0 months (P = 0.14) for the primary and secondary groups, respectively.
Laparoscopic pyeloplasty is an excellent option for patients who failed previous surgical management. This approach provides durable long-term outcomes comparable with those of primary treatment for ureteropelvic junction obstruction.
评估初次干预失败后继发输尿管肾盂连接部梗阻患者行腹腔镜肾盂成形术的长期效果。
2000年8月至2012年10月期间，对13例既往手术干预失败的患者实施经腹离断式腹腔镜肾盂成形术。评估围手术期结局及长期效果。将这些结果与同一研究期间同一位外科医生对原发性输尿管肾盂连接部梗阻实施相同手术的结果进行比较。
所有病例均成功完成腹腔镜经腹肾盂成形术，无一例转为开放手术或需要输血。13例患者中有12例术前症状在术后不久均消失。一名2岁男孩术前发现的无症状重度肾积水术后体积缩小。当比较同一位外科医生实施的原发性与继发性腹腔镜肾盂成形术时，继发性组的平均手术时间更长（183分钟对241分钟，P = 0.002），估计失血量更大（33毫升对66毫升，P = 0.03），并发症发生率更高（8.8%对22.2%，P = 0.01）。原发性组和继发性组平均随访25.9个月和40.0个月时的成功率分别为97.9%和100%（P = 0.41）（P = 0.14）。
腹腔镜肾盂成形术是既往手术治疗失败患者的极佳选择。这种方法可提供与原发性输尿管肾盂连接部梗阻治疗相当的持久长期效果。
