CAJ | 학술논문

目的探讨肾异位血管压迫所致肾盂输尿管连接部梗阻(UPJO)的临床诊治以及手术效果.方法回顾性分析2001年6月至2011年9月北京大学第三医院泌尿外科收治因异位血管压迫引起的24例UPJO患者的临床资料,其中男性17例,女性7例;年龄2～ 63岁,平均28岁.病程7d至180个月,平均22.3个月.患者均有患侧肾积水.4例行开放手术,20例行后腹腔镜手术,根据术中异位血管压迫情况决定行粘连松解术、肾盂离断成形术(即Anderson-Hynes术)或非离断成形术(即Y-V吻合术),同时保留或切断压迫的异位血管.术后定期随访患者并评价手术效果.结果术中发现15例为异位动脉压迫肾盂输尿管连接部(UPJ),8例为异位静脉压迫UPJ(7例为单支,1例为双支),另1例为2支异位动脉与1支异位静脉压迫UPJ.术后11例获得长期随访,随访时间13～120个月,平均48.2个月.8例(8/11)患者临床症状或肾积水缓解,1例(1/11)患者无明显改善,2例(2/11)加重.6例行单纯松解粘连或同时结扎异位血管的患者中,3例缓解,1例无明显改善,2例加重.5例行肾盂离断成形术的患者随访均明显缓解.结论肾异位动脉所致UPJO较为常见,术中应尽量保留异位动脉.由于异位血管压迫不是导致UPJO的唯一病理原因,对UPJ狭窄部的处理同样重要,肾盂离断成形术的效果确切,而单纯松解粘连效果有限.
목적 탐토신이위혈관압박소치신우수뇨관련접부경조(UPJO)적림상진치이급수술효과.방법 회고성분석2001년6월지2011년9월북경대학제삼의원비뇨외과수치인이위혈관압박인기적24례UPJO환자적림상자료,기중남성17례,녀성7례;년령2～ 63세,평균28세.병정7d지180개월,평균22.3개월.환자균유환측신적수.4례행개방수술,20례행후복강경수술,근거술중이위혈관압박정황결정행점련송해술、신우리단성형술(즉Anderson-Hynes술)혹비리단성형술(즉Y-V문합술),동시보류혹절단압박적이위혈관.술후정기수방환자병평개수술효과.결과 술중발현15례위이위동맥압박신우수뇨관련접부(UPJ),8례위이위정맥압박UPJ(7례위단지,1례위쌍지),령1례위2지이위동맥여1지이위정맥압박UPJ.술후11례획득장기수방,수방시간13～120개월,평균48.2개월.8례(8/11)환자림상증상혹신적수완해,1례(1/11)환자무명현개선,2례(2/11)가중.6례행단순송해점련혹동시결찰이위혈관적환자중,3례완해,1례무명현개선,2례가중.5례행신우리단성형술적환자수방균명현완해.결론 신이위동맥소치UPJO교위상견,술중응진량보류이위동맥.유우이위혈관압박불시도치UPJO적유일병리원인,대UPJ협착부적처리동양중요,신우리단성형술적효과학절,이단순송해점련효과유한.
Objective To investigate the diagnosis,treatment and surgical outcomes of ureteropelvic junction obstruction (UPJO) caused by renal crossing vessels.Methods The case records of 24 patients discharged from Peking University Third Hospital between June 2001 and September 2011 with the diagnosis of UPJO caused by renal crossing vessels were reviewed.Of the 24 patients,17 were male and 7 were female patients.The mean age was 28 years (range,2-63 years).The mean disease duration was 22.3 months (range,7 days to 180 months).Of which,4 patients underwent open surgery,and the other 20 patients were treated with laparoscopic surgery.Surgical approach was decided by operative conditions:adhesion release technique,dismembered pyeloplasty or Y-V anastomosisor,with or without cut off the crossing vessels.The kind of crossing vessels was recorded,and the effect of surgery was evaluated by follow-up.Results Fifteen cases were caused by oppressed renal crossing artery,8 cases by renal crossing vein,and 1 case by 2 renal crossing arteries and 1 renal crossing vein.Among them,11 cases were followed up successfully.Average follow-up time was 48.2 months (range,13-120 months).Eight cases (8/11) were relieved,and 1 case(1/11) had no obvious improvement,another 2 cases(2/11) were aggravating.Among those 6 cases underwent adhesion release technique,3 cases were relieved,1 case had no obvious improvement,and 2 cases were aggravating.Five cases who underwent dismembered pyeloplasty was relieved significantly.Conclusions Renal crossing artery is one of the main causes of UPJO,the crossing artery should be retained as far as possible.Crossing vessel oppression is not the only pathological cause of UPJO,so the treatment of UPJ constriction is also very important.Dismembered pyeloplasty seems to be the most efficacies treatment procedure for UPJO caused by repressed vessels,and the remission rate of adhesion release technique seems limited.