CAJ | 학술논문

目的：介绍两部位鞘管穿刺腹腔镜Anderson-Hynes肾盂输尿管成形术，探讨其在儿童腹腔镜Anderson-Hynes肾盂输尿管成形术中的应用价值。方法收集2010年至2013年于本院采用腹腔镜Anderson-Hynes肾盂输尿管成形术治疗、继发于肾盂输尿管连接处梗阻（ureteropelvic junction obstruc-tion，UPJO）的肾积水病例149例。根据鞘管穿刺方式分为两部位组及三部位组。其中两部位组69例，男53例，女16例，双侧3例，单侧66例。三部位组80例，男71例，女9例，双侧4例，单侧76例。两组均行腹腔镜Anderson-Hynes肾盂输尿管成形术，手术均由同一医生完成。术后随访12个月，了解肾积水及尿路感染情况。比较两组手术时间、术中及术后并发症、远期再手术率及术后恢复情况。结果均顺利完成手术，无中转开放手术，无添加鞘管或切口。两部位组及三部位组平均手术时间分别为（95±39）min、（122±42）min（P＝0．000），术后肾收集系统扩张分离前后径（anterior-posterior，AP）为（1．5±1.2）cm、（1．2±0．9）cm（P＝0．167）。术后并发症的发生率分别为17．4％、13．8％，肾积水完全缓解率分别为40．6％、42．5％，两部位组术后1年出现2例再手术病例（3．2％），第1例再手术病例术中发现原肾盂输尿管吻合处有瓣膜状结构，可能为第1次手术缝合时管周筋膜坎如吻合口所致。第2例为输尿管息肉复发病例。三部位组无再手术病例。结论采用两部位法腹腔镜Anderson-Hynes肾盂输尿管成形术安全有效，且可以减轻手术瘢痕，体现腹腔镜“无疤”效果。
목적：개소량부위초관천자복강경Anderson-Hynes신우수뇨관성형술，탐토기재인동복강경Anderson-Hynes신우수뇨관성형술중적응용개치。방법수집2010년지2013년우본원채용복강경Anderson-Hynes신우수뇨관성형술치료、계발우신우수뇨관련접처경조（ureteropelvic junction obstruc-tion，UPJO）적신적수병례149례。근거초관천자방식분위량부위조급삼부위조。기중량부위조69례，남53례，녀16례，쌍측3례，단측66례。삼부위조80례，남71례，녀9례，쌍측4례，단측76례。량조균행복강경Anderson-Hynes신우수뇨관성형술，수술균유동일의생완성。술후수방12개월，료해신적수급뇨로감염정황。비교량조수술시간、술중급술후병발증、원기재수술솔급술후회복정황。결과균순리완성수술，무중전개방수술，무첨가초관혹절구。량부위조급삼부위조평균수술시간분별위（95±39）min、（122±42）min（P＝0．000），술후신수집계통확장분리전후경（anterior-posterior，AP）위（1．5±1.2）cm、（1．2±0．9）cm（P＝0．167）。술후병발증적발생솔분별위17．4％、13．8％，신적수완전완해솔분별위40．6％、42．5％，량부위조술후1년출현2례재수술병례（3．2％），제1례재수술병례술중발현원신우수뇨관문합처유판막상결구，가능위제1차수술봉합시관주근막감여문합구소치。제2례위수뇨관식육복발병례。삼부위조무재수술병례。결론채용량부위법복강경Anderson-Hynes신우수뇨관성형술안전유효，차가이감경수술반흔，체현복강경“무파”효과。
Objetive To describe the clinical efficacy of two-site trocar placement of laparoscopic An-derson-Hynes pyeloplasty for the treatment of UPJO in children. Methods A total of 1 49 children (from 201 0 to 201 3)with UPJO were enrolled in this study.The patients were divided into two-site and three-site group ac-cording to the pattern of the trocar placement.two-site group(69 cases),including 53 males and 1 6 females, were made up of 3 bilateral and 66 unilateral.three-site group(80 cases),including 71 males and 9 females, were made up of 4 bilateral and 76 unilateral.All the patients underwent laparoscopic Anderson-Hynes pyelo-plasty by the same surgeon.The follow-up period was 1 2 months,B ultrasonography was used to followe the de-gree of the hydronephrosis,urinalysis for the urinary tract infection.Comparison in terms of operative duration, complication rate,reintervention rate and therapeutic efficacy was made. Results The procedure was comple-ted in all,no case converted to open surgery and add extra trocars or incision.Significant difference was found in operative time [(95 ±41 )min vs (1 22 ±42)min P=0.000],But no significant difference was found in An-terior-Posterior [(1 .5 ±1 .2)cm vs (1 .2 ±0.9)cm P=0.1 67]between the two groups.Complication rate was 1 7.4% and 1 3.8%,complete remission rate was 40.6%and 42.5%,2 cases in two-site group were reinter-vened one year later. Conclusion Two-site trocar placement of laparoscopic Anderson-Hynes pyeloplasty is clinical efficacy and,moreover,improved cosmesis.