开放手术与腔内泌尿外科手术治疗输尿管肾盂连接部梗阻的比较

Comparison of open and endourologic approaches to the obstructed ureteropelvic junction.

作者信息

Brooks J D, Kavoussi L R, Preminger G M, Schuessler W W, Moore R G

机构信息

James Buchanan Brady Urological Institute, Johns Hopkins Bayview Medical Center, Baltimore, MD 21224, USA.

出版信息

Urology. 1995 Dec;46(6):791-5. doi: 10.1016/S0090-4295(99)80345-8.

DOI:10.1016/S0090-4295(99)80345-8

PMID:7502417

Abstract

OBJECTIVES

To compare open pyeloplasty with three minimally invasive modalities: antegrade endopyelotomy, Acucise endopyelotomy (Applied Medical, Laguna Hills, Calif), and laparoscopic pyeloplasty.

METHODS

Forty-five adult patients with ureteropelvic junction obstruction were managed by one of the above four techniques. Success rates, analgesic use, length of hospital stay, recovery time, and complications were compared between each of the four groups.

RESULTS

Successful relief of obstruction was achieved in 100% of patients undergoing open and laparoscopic dismembered pyeloplasty, 78% undergoing Acucise endopyelotomy, and 77% undergoing antegrade percutaneous endopyelotomy. Acucise endopyelotomy results in shorter convalescence (1 week) than antegrade endopyelotomy (4.7 weeks), laparoscopic pyeloplasty (2.3 weeks) or open pyeloplasty (10.3 weeks). Complication rates appear to be similar among all groups.

CONCLUSIONS

Our limited data imply that Acucise endopyelotomy offers low morbidity with success rates comparable to antegrade pyeloplasty, whereas laparoscopic pyeloplasty is as effective as open pyeloplasty with diminished morbidity.

摘要

目的

比较开放性肾盂成形术与三种微创术式：顺行性内镜肾盂切开术、Acucise内镜肾盂切开术（应用医疗公司，加利福尼亚州拉古纳希尔斯）和腹腔镜肾盂成形术。

方法

45例患有输尿管肾盂连接部梗阻的成年患者接受了上述四种技术中的一种治疗。比较了四组患者的成功率、镇痛药物使用情况、住院时间、恢复时间及并发症。

结果

接受开放性和腹腔镜离断性肾盂成形术的患者梗阻均成功解除，成功率为100%；接受Acucise内镜肾盂切开术的患者成功率为78%，接受顺行性经皮内镜肾盂切开术的患者成功率为77%。Acucise内镜肾盂切开术的恢复期（1周）比顺行性内镜肾盂切开术（4.7周）、腹腔镜肾盂成形术（2.3周）或开放性肾盂成形术（10.3周）短。所有组的并发症发生率似乎相似。