CAJ | 학술논문

目的介绍经背部小切口入路离断式肾盂成形术治疗先天性肾盂输尿管连接处梗阻(UPJO)所致肾积水的方法及疗效.方法 2012年3月至2015年1月我科应用经背部小切口入路离断式肾盂成形术治疗40例UPJO患儿,SFU分级Ⅳ级,男33例,女7例,年龄1～12个月,其中左侧26例,右侧13例,双侧1例.术前B型超声检查示肾盂前后径2.7～5.8 cm.手术方法:患儿取俯卧位,取患侧背部12肋下1 cm处脊柱外缘横切口,长约2.0 cm,依次切开皮肤、皮下组织,纵向切开胸腰筋膜,沿腰大肌外缘向深部钝性分离,暴露患侧肾脏,经肾盂穿刺减压后,分离肾盂周围组织并将肾盂及UPJ部提出切口外进行操作,常规行Anderson-Hynes离断式肾盂成形术.术后常规行B型超声检查随访.结果本组40例患儿均顺利完成手术,梗阻原因均为肾盂输尿管连接部狭窄所致,狭窄段长约0.5～2.5 cm,术中放置双J管30例.手术时间50～70 min;术中出血10～20ml;术后4～5 d出院.术后切口愈合好,无明显瘢痕,较美观.术后并发症3例:肾盂输尿管吻合口漏尿、吻合口梗阻、泌尿系感染各1例.术后随访6～39个月,所有患儿(包括并发症处理后患儿)术后B型超声随访检查肾积水较术前均有好转,肾皮质较术前增厚,肾盂前后径较术前减小.结论对于婴幼儿、肾外型肾盂的UPJO患儿,经背部小切口入路为较好的微创方式,适于临床开展.
목적 개소경배부소절구입로리단식신우성형술치료선천성신우수뇨관련접처경조(UPJO)소치신적수적방법급료효.방법 2012년3월지2015년1월아과응용경배부소절구입로리단식신우성형술치료40례UPJO환인,SFU분급Ⅳ급,남33례,녀7례,년령1～12개월,기중좌측26례,우측13례,쌍측1례.술전B형초성검사시신우전후경2.7～5.8 cm.수술방법:환인취부와위,취환측배부12륵하1 cm처척주외연횡절구,장약2.0 cm,의차절개피부、피하조직,종향절개흉요근막,연요대기외연향심부둔성분리,폭로환측신장,경신우천자감압후,분리신우주위조직병장신우급UPJ부제출절구외진행조작,상규행Anderson-Hynes리단식신우성형술.술후상규행B형초성검사수방.결과 본조40례환인균순리완성수술,경조원인균위신우수뇨관련접부협착소치,협착단장약0.5～2.5 cm,술중방치쌍J관30례.수술시간50～70 min;술중출혈10～20ml;술후4～5 d출원.술후절구유합호,무명현반흔,교미관.술후병발증3례:신우수뇨관문합구루뇨、문합구경조、비뇨계감염각1례.술후수방6～39개월,소유환인(포괄병발증처리후환인)술후B형초성수방검사신적수교술전균유호전,신피질교술전증후,신우전후경교술전감소.결론 대우영유인、신외형신우적UPJO환인,경배부소절구입로위교호적미창방식,괄우림상개전.
Objective To evaluate the technique and clinical efficacy of adopting a dorsal paravertebral transverse incision for infantile ureteropelvic junction obstruction (UPJO).Methods A total of 40 infants aged 1-12 months with large dilated pelvises underwent miniature pyeloplasty.Surgical access was gained through a 2.0 cm dorsal paravertebral transverse muscle-splitting incision.After a meticulous dissection of ureteropelvic junction component,the affected section was extracted for classic dismembered pyeloplasty.Thirty of them had long-term stented anastomoses.Ultrasonographic follow-ups were conducted.Operative duration,hospital stay and complication rate were compared.Results Miniature pyeloplasty was successful in all patients.The overall operative duration had a range of 50-70 min.They were discharged after 4-5 days.Three major complications were anastomotic stricture (n =1),urinary infiltration (n =1) and urinary infection (n =1).During a follow-up period of 6-39 months,postoperative radiological improvements were observed and all of them recovered from complications.Conclusions Miniature pyeloplasty via a small incision is both safe and effective in the treatment of UPJO in young infants with large renal pelvis.