Lim D J, Walker R D
Department of Surgery, University of Florida, Gainesville, USA.
J Urol. 1996 Aug;156(2 Pt 2):738-40. doi: 10.1097/00005392-199608001-00048.
We present our experience with repeat surgery for persistent ureteropelvic junction obstruction.
We retrospectively reviewed the records of patients who underwent pyeloplasty for ureteropelvic junction obstruction between 1984 and 1994, focusing on those who underwent repeat surgery for persistent ureteropelvic junction obstruction after initial pyeloplasty.
During the 10-year period 127 pyeloplasties were done by a single surgeon (R. D. W.). Three cases of persistent ureteropelvic junction obstruction occurred in this primary pyeloplasty series (success rate 97.6%). During the same period 9 other patients were referred to us from elsewhere for persistent ureteropelvic junction obstruction after initial pyeloplasty (total 12 patients). Ten patients underwent repeat pyeloplasty with a postoperative stent in place. Two patients needed nephrectomy at the initial repeat procedure and 1 of the 10 repeat pyeloplasty patients ultimately underwent nephrectomy. Six patients who had recurrent ureteropelvic junction obstruction were younger than 6 months at the time of the original pyeloplasty. Excessive urinary drainage was noted in 2 of our 3 cases of failed pyeloplasty. Thus, in 9 patients satisfactory resolution of obstruction was achieved by repeat pyeloplasty (salvage rate 75%).
Persistent ureteropelvic junction obstruction is an uncommon complication after pyeloplasty. Infants who undergo pyeloplasty may be more prone to persistent obstruction after pyeloplasty. Prolonged urinary drainage seems to be a harbinger of persistent ureteropelvic junction obstruction. Careful repeat pyeloplasty with attention to preservation of the blood supply and meticulous watertight anastomosis led to satisfactory resolution of ureteropelvic junction obstruction in 75% of the cases.
我们介绍了对持续性肾盂输尿管连接部梗阻进行再次手术的经验。
我们回顾性分析了1984年至1994年间因肾盂输尿管连接部梗阻接受肾盂成形术患者的记录，重点关注初次肾盂成形术后因持续性肾盂输尿管连接部梗阻而接受再次手术的患者。
在这10年期间，由一位外科医生（R.D.W.）完成了127例肾盂成形术。在这个初次肾盂成形术系列中发生了3例持续性肾盂输尿管连接部梗阻（成功率97.6%）。同期，另外9例患者因初次肾盂成形术后持续性肾盂输尿管连接部梗阻从其他地方转诊至我们这里（共12例患者）。10例患者在术后留置支架的情况下接受了再次肾盂成形术。2例患者在初次再次手术时需要进行肾切除术，10例再次肾盂成形术患者中有1例最终接受了肾切除术。6例复发性肾盂输尿管连接部梗阻患者在初次肾盂成形术时年龄小于6个月。我们3例肾盂成形术失败的病例中有2例出现了过多的尿液引流。因此，9例患者通过再次肾盂成形术实现了梗阻的满意缓解（挽救率75%）。
持续性肾盂输尿管连接部梗阻是肾盂成形术后罕见的并发症。接受肾盂成形术的婴儿在术后可能更容易出现持续性梗阻。长时间的尿液引流似乎是持续性肾盂输尿管连接部梗阻的先兆。仔细进行再次肾盂成形术，注意保留血供并进行细致的水密吻合，在75%的病例中导致了肾盂输尿管连接部梗阻的满意缓解。
