CAJ | 학술논문

目的：探讨经脐单孔腹腔镜下离断性肾盂成形术治疗肾盂输尿管连接处梗阻的可行性和安全性。方法选取2011年3月至2012年3月收治的8例肾盂输尿管连接处梗阻患者，男5例，女3例。年龄16～45岁，平均28岁。6例表现为患侧腰部胀痛，2例体检发现。病变位于左侧7例，右侧1例。行B超、IVU和/或CTU检查示患侧肾积水，肾盂输尿管连接处梗阻；利尿肾图检查示患侧肾功能减退。8例均无腹部手术史。全麻下行经脐单孔腹腔镜下离断性肾盂成形术，于脐部上缘做2．0～2．5 cm长的弧形切口，置入单孔多通道套件，放入30°5 mm或10 mm腹腔镜，使用传统腹腔镜器械及预弯器械完成手术。结果本组8例手术均顺利完成，无中转开放手术或传统腹腔镜手术。手术时间117～190 min，平均153 min；估计失血量10～40 ml，平均20 ml。术后平均1．5 d恢复肠道功能，2～7 d拔除引流管，术后住院时间4～8 d，平均6 d。术后随访3～6个月，症状均消失，行利尿性肾图、IVU及B超检查示肾积水明显减轻或消失，未见吻合口狭窄等手术并发症。结论经脐单孔腹腔镜下离断性肾盂成形术治疗肾盂输尿管连接处梗阻安全、有效，具有手术创伤小、术后恢复快、美容效果好等优点。
목적：탐토경제단공복강경하리단성신우성형술치료신우수뇨관련접처경조적가행성화안전성。방법선취2011년3월지2012년3월수치적8례신우수뇨관련접처경조환자，남5례，녀3례。년령16～45세，평균28세。6례표현위환측요부창통，2례체검발현。병변위우좌측7례，우측1례。행B초、IVU화/혹CTU검사시환측신적수，신우수뇨관련접처경조；이뇨신도검사시환측신공능감퇴。8례균무복부수술사。전마하행경제단공복강경하리단성신우성형술，우제부상연주2．0～2．5 cm장적호형절구，치입단공다통도투건，방입30°5 mm혹10 mm복강경，사용전통복강경기계급예만기계완성수술。결과본조8례수술균순리완성，무중전개방수술혹전통복강경수술。수술시간117～190 min，평균153 min；고계실혈량10～40 ml，평균20 ml。술후평균1．5 d회복장도공능，2～7 d발제인류관，술후주원시간4～8 d，평균6 d。술후수방3～6개월，증상균소실，행이뇨성신도、IVU급B초검사시신적수명현감경혹소실，미견문합구협착등수술병발증。결론경제단공복강경하리단성신우성형술치료신우수뇨관련접처경조안전、유효，구유수술창상소、술후회복쾌、미용효과호등우점。
Objective To evaluate the feasibility and safety of transumbilical laparoendoscopic sin-gle-site dismembered pyeloplasty ( U-LESS-P ) for the treatment of ureteropelvic junction obstruction (UPJO). Methods Between Mar.2011 and Mar.2012, U-LESS-P was performed in 8 consecutive pa-tients with UPJO by one experienced laparoscopic surgeon .The patients included 5 males and 3 females, with an average age of 28 (16-45) years.Of the 8 patients, six presented with flank pain , and two were a-symptomatic and discovered incidentally by health check .Of the 8 patients, seven had UPJO on the left side and one on the right side .The diagnosis was established by renal ultrasonography , diuretic renal scan , intra-venous urography (IVU) or/and computed tomography urography (CTU).Renal ultrasonography, IVU and ( or) CTU showed hydronephrosis and UPJO in the affected side , while diuretic renal scan demonstrated re-nal function deteriorated .No patients had undergone abdominal surgery previously .A 2-2.5 cm umbilical in-cision was made for single-port access .The procedures were performed using 30°5 mm or 10 mm laparoscope with a combination of conventional and bent laparoscopic instruments . Results All procedures were com-pleted successfully .None was converted to open surgery or traditional laparoscopic surgery .The mean opera-tive time was 153 (117-190) min, and the average estimated blood loss about 20 (10-40) ml.The mean time to resume oral diet was 1.5 days.The drainage remained 2-7 days.The mean hospital stay was 6 (4-8) days.With the follow-up of 3-6 months, symptom-free was investigated in all 8 cases.Ultrasonography , diuretic renal scan and IVU showed decreased or disappeared hydronephrosis .No operative complication , such as anastomotic stoma stenosis , was founded . Conclusions U-LESS-P is a safe and effective proce-dure for the treatment of UPJO , with the advantages of decreased operative morbidity , postoperative rapid re-covery and improved cosmetic result .