Orland S M, Snyder H M, Duckett J W
Division of Urology, Children's Hospital of Philadelphia, University of Pennsylvania School of Medicine.
J Urol. 1987 Oct;138(4 Pt 2):963-6. doi: 10.1016/s0022-5347(17)43472-0.
Between January 1, 1983 and September 30, 1985, 42 upper urinary tract operations were performed using the dorsal lumbotomy incision, representing 28 per cent of all upper tract procedures performed. Operations included pyeloplasty, partial and total nephroureterectomy, pyelolithotomy, ureterolithotomy and renal exploration with cyst marsupialization. The major contraindications to lumbotomy were malignancy and malrotated or malpositioned kidneys. Patient age ranged from 1 month to 20 years. A modification of the Gil-Vernet vertical lumbotomy incision was used in all cases. This approach involves successive incisions through the layers of the lumbodorsal fascia to gain access to the kidney and ureter, and emphasizes a muscle-retracting technique. Incision of the costovertebral ligament allows 12th rib elevation and improves the exposure obtained. There were no postoperative complications related to the lumbotomy incision itself. Decreased surgical morbidity is suggested by our results. By 3 days postoperatively 64 per cent of our patients required no analgesic medication, 93 per cent were tolerating a regular diet and 83 per cent were evaluated as having a good appetite. Mean hospital length of stay for all lumbotomy patients was 5.6 days. We conclude that the dorsal lumbotomy incision can be used to perform a wide variety of upper tract operations in children, resulting in minimal morbidity and short hospital stays.
1983年1月1日至1985年9月30日期间，采用背侧腰部切口进行了42例上尿路手术，占所有上尿路手术的28%。手术包括肾盂成形术、部分及全肾输尿管切除术、肾盂切开取石术、输尿管切开取石术以及肾探查并囊肿造袋术。腰部切口的主要禁忌证为恶性肿瘤以及肾脏旋转不良或位置异常。患者年龄从1个月至20岁不等。所有病例均采用改良的吉尔 - 韦尔内垂直腰部切口。该方法包括依次切开腰背筋膜各层以显露肾脏和输尿管，并强调肌肉牵开技术。切开肋椎韧带可使第12肋上抬，改善显露。未出现与腰部切口本身相关的术后并发症。我们的结果提示手术发病率降低。术后3天时，64%的患者无需镇痛药物，93%的患者能耐受正常饮食，83%的患者食欲良好。所有腰部切口患者的平均住院时间为5.6天。我们得出结论，背侧腰部切口可用于小儿多种上尿路手术，发病率低且住院时间短。
