Fahmy Omar, El-Fayoumi Abdel-Rahman, Gakis Georgios, Amend Bastian, Khairul-Asri Mohd Ghani, Stenzl Arnulf, Schwentner Christian
Eberhard Karls Tuebingen University, Department of Urology, Tuebingen, Germany.
Zagazig University, Department of Urology, Zagazig, Egypt.
Cent European J Urol. 2015;68(4):466-70. doi: 10.5173/ceju.2015.627. Epub 2015 Dec 21.
Laparoscopic pyeloplasty is considered a standard treatment for ureteropelvic junction obstruction (UPJO). However, the presence of another pathology makes it a more challenging operation and guides the surgeon towards open conversion. In this study, we present our experience in difficult pyeloplasty cases managed by laparoscopy.
Six patients (4 females and 2 males) with an average age of 44 and a range of 27 to 60 years old, were diagnosed for UPJO. Three were on the left side and 3 on the right side. In addition to UPJO, 2 patients had renal stones, one patient had both renal ptosis and an umbilical hernia, 3 patients had a para-pelvic cyst, hepatomegaly and malrotated kidney, respectively. All patients had a preoperative ultrasound, CT or IVU, and a renal isotope scan. Laparoscopic pyeloplasty was performed according to the dismembered Anderson-Hynes technique with auxiliary maneuver, according to the pathology.
All patients were treated successfully for UPJO and the concomitant pathologies, except hepatomegaly and malrotation. Mean operative time was 125 minutes and estimated blood loss was <50 ml.
Laparoscopic pyeloplasty can be performed in difficult situations provided that the surgeon has enough experience with laparoscopy.
腹腔镜肾盂成形术被认为是治疗肾盂输尿管连接部梗阻（UPJO）的标准方法。然而，存在其他病理情况会使其成为更具挑战性的手术，并促使外科医生转为开放手术。在本研究中，我们介绍了我们在腹腔镜处理困难肾盂成形术病例方面的经验。
6例患者（4例女性，2例男性），平均年龄44岁，年龄范围为27至60岁，被诊断为UPJO。3例在左侧，3例在右侧。除UPJO外，2例患者有肾结石，1例患者既有肾下垂又有脐疝，3例患者分别有肾盂旁囊肿、肝肿大和肾旋转不良。所有患者术前均进行了超声、CT或静脉肾盂造影（IVU）以及肾同位素扫描。根据病理情况，采用改良安德森 - 海恩斯技术并辅以相应操作进行腹腔镜肾盂成形术。
除肝肿大和肾旋转不良外，所有患者的UPJO及合并的病理情况均得到成功治疗。平均手术时间为125分钟，估计失血量<50毫升。
只要外科医生有足够的腹腔镜手术经验，在困难情况下也可进行腹腔镜肾盂成形术。
