Abraham George P, Siddaiah Avinash T, Ramaswami Krishnamohan, George Datson, Das Krishanu
Department of Urology, Lakeshore Hospital and Research Centre, Kochi, Kerala, India.
Urol Ann. 2015 Apr-Jun;7(2):183-7. doi: 10.4103/0974-7796.150489.
The aim was to analyze the operative, postoperative and functional outcome of laparoscopic management of previously failed pyeloplasty and to compare operative and postoperative outcome with laparoscopic pyeloplasty for primary ureteropelvic junction obstruction (UPJO).
All patients who underwent laparoscopic management for previously failed dismembered pyeloplasty were analyzed in this study. Detailed clinical and imaging evaluation was performed. Transperitoneal approach was followed to repair the recurrent UPJO. Operative, postoperative, and follow-up functional details were recorded. Operative and postoperative outcomes of laparoscopic redo pyeloplasty were compared with that of laparoscopic primary pyeloplasty.
A total of 16 patients were managed with laparoscopic approach for previously failed pyeloplasty. Primary surgical approach for dismembered pyeloplasty was open in 11, laparoscopy in four patients and robotic assisted in one patient. Fifteen were treated with redo pyeloplasty and one with ureterocalicostomy. Mean operative time was 191.25 ± 24.99 min, mean duration of hospital stay was 3.2 ± 0.45 days and mean follow-up duration was 29.9 ± 18.5 months with success rate of 93.3%. Operative time was significantly prolonged with redo pyeloplasty group compared with primary pyeloplasty group (191.25 ± 24.99 vs. 145 ± 22.89, P = 0.0001).
Laparoscopic redo pyeloplasty is a viable option with a satisfactory outcome and less morbidity.
分析腹腔镜处理既往肾盂成形术失败病例的手术、术后及功能结局，并将其手术和术后结局与腹腔镜肾盂成形术治疗原发性输尿管肾盂连接部梗阻（UPJO）进行比较。
本研究分析了所有接受腹腔镜处理既往离断性肾盂成形术失败病例的患者。进行了详细的临床和影像学评估。采用经腹途径修复复发性UPJO。记录手术、术后及随访的功能细节。将腹腔镜肾盂成形术再次手术的手术和术后结局与腹腔镜原发性肾盂成形术的结局进行比较。
共有16例患者接受了腹腔镜处理既往肾盂成形术失败病例。离断性肾盂成形术的初次手术方式中，11例为开放手术，4例为腹腔镜手术，1例为机器人辅助手术。15例行肾盂成形术再次手术，1例行输尿管肾盂造口术。平均手术时间为191.25±24.99分钟，平均住院时间为3.2±0.45天，平均随访时间为29.9±18.5个月，成功率为93.3%。与原发性肾盂成形术组相比，肾盂成形术再次手术组的手术时间显著延长（191.25±24.99对145±22.89，P = 0.0001）。
腹腔镜肾盂成形术再次手术是一种可行的选择，结局满意且并发症较少。
