Guliev B G
Department of Urology, I.I. Mechnikov North-Western State Medical University, St. Petersburg.
Urologiia. 2016 Nov(5):58-62.
Horseshoe kidney is often associated with other congenital abnormalities and obstruction of pyeloureteral segment (PUS). The aim of our study was to evaluate the results of laparoscopic pyeloplasty (LP) in patients with hydronephrosis of horseshoe kidney.
From February 2010 to March 2016, 130 patients underwent LP. Ten (7.7%) of them (6 men and 4 women) had a hydronephrosis of horseshoe kidney. Left and right PUS obstruction were diagnosed in 6 and 4 patients, respectively. All the patients underwent PL transperitoneally using the Anderson-Hynes method. In patients with left hydronephrosis, surgery was performed by transmesenteric access.
There were no cases of conversion to open surgery and drainage urine leakage. Exacerbation of chronic pyelonephritis was observed in 2 cases. Operating time ranged from 125 to 160 minutes (median 130 minutes), time of performing pyeloureteral anastomosis - from 50 to 105 minutes. Patients were ambulated within the first day after surgery, the length of hospital stay was 3 - 4 days. One patient with recurrent strictures of PUS 8 months after the LP underwent retrograde endopyelotomy with the placement of endopyelotomy stent. The effectiveness of operations over a 6-38 month follow-up was 90%.
LP is an effective and minimally invasive treatment for patients with hydronephrosis of horseshoe kidney. In a left PUS obstruction, pyeloplasty can be performed using transmesenteric access.
马蹄肾常伴有其他先天性异常及肾盂输尿管段（PUS）梗阻。本研究的目的是评估腹腔镜肾盂成形术（LP）治疗马蹄肾肾积水患者的效果。
2010年2月至2016年3月，130例患者接受了LP手术。其中10例（7.7%）（6例男性和4例女性）患有马蹄肾肾积水。分别在6例和4例患者中诊断出左侧和右侧PUS梗阻。所有患者均采用Anderson-Hynes方法经腹腔进行PL手术。对于左侧肾积水患者，通过经肠系膜入路进行手术。
无转为开放手术及引流尿液漏出的病例。2例患者出现慢性肾盂肾炎加重。手术时间为125至160分钟（中位时间130分钟），肾盂输尿管吻合时间为50至105分钟。患者术后第一天即可下床活动，住院时间为3 - 4天。1例患者在LP术后8个月出现PUS复发性狭窄，接受了逆行肾盂内切开术并置入肾盂内切开支架。在6至38个月的随访中，手术有效率为90%。
LP是治疗马蹄肾肾积水患者的一种有效且微创的方法。对于左侧PUS梗阻，可采用经肠系膜入路进行肾盂成形术。
