CAJ | 학술논문

目的分析腹腔镜双侧Anderson-Hynes肾盂输尿管成形术治疗儿童双侧先天性肾盂输尿管连接处梗阻(ureteropelvic j unction obstruction,UPJO)导致的肾积水的可行性、安全性、疗效和优势.方法双侧UPJO所致肾积水15例(30侧).其中男13例,女2例.年龄1岁～13岁5个月,中位年龄5岁.临床表现为术前伴腰痛7例,伴尿路感染2例,双侧腹部包块4例,单侧腹部包块4例,其中单侧巨大肾积水2例.均采用经脐部(2孔)和脐部与剑突下连线中点(1孔)两部位放置穿刺鞘管,一次性腹腔镜下双侧Anderson-Hynes肾盂输尿管成形术.手术均由同一医生完成.术后随访12～24个月,连续B型超声检测AP值变化,必要时IVU,尿常规评估疗效.分析中转开放率、手术时间、术中出血量、术后住院时间、并发症及术后肾积水缓解程度、再手术率.结果 15例手术均获成功,无中转开放,无添加鞘管或切口.手术时间(180±60)min,术中出血量(21.6±13.9)ml,术后住院天数(10.1±2.0)d.术中发现单侧重复肾Y形输尿管1例,双侧输尿管息肉1例,单侧输尿管息肉1例,双侧迷走血管压迫1例.1例于术后3d因单侧支架管堵塞而尿外渗至肠动力性降低,术后通过禁食及胃肠减压后自行治愈.3例术后24 h后仍有明显肉眼血尿,通过延长止血药的使用血尿消失,无明显高碳酸血症、内环境紊乱等CO2气腹相关并发症,无其他胃肠动力减弱或机械性梗阻病例发生.无ClavienⅢ级手术并发症.术后12个月10例20侧(66.7％)获得随访,在20侧患肾中,10侧(50％)肾积水完全缓解,10侧(50％)部分缓解.术后24个月14侧(70％)获得完全缓解,6侧(30％)部分缓解,无再次手术病例.结论经脐部(2孔)和脐部与剑突下连线中点(1孔)两部位鞘管穿刺,腹腔镜下双侧Anderson-Hynes肾盂输尿管成形术治疗儿童UPJO安全有效,术后效果良好,具有微创优势.
목적 분석복강경쌍측Anderson-Hynes신우수뇨관성형술치료인동쌍측선천성신우수뇨관련접처경조(ureteropelvic j unction obstruction,UPJO)도치적신적수적가행성、안전성、료효화우세.방법 쌍측UPJO소치신적수15례(30측).기중남13례,녀2례.년령1세～13세5개월,중위년령5세.림상표현위술전반요통7례,반뇨로감염2례,쌍측복부포괴4례,단측복부포괴4례,기중단측거대신적수2례.균채용경제부(2공)화제부여검돌하련선중점(1공)량부위방치천자초관,일차성복강경하쌍측Anderson-Hynes신우수뇨관성형술.수술균유동일의생완성.술후수방12～24개월,련속B형초성검측AP치변화,필요시IVU,뇨상규평고료효.분석중전개방솔、수술시간、술중출혈량、술후주원시간、병발증급술후신적수완해정도、재수술솔.결과 15례수술균획성공,무중전개방,무첨가초관혹절구.수술시간(180±60)min,술중출혈량(21.6±13.9)ml,술후주원천수(10.1±2.0)d.술중발현단측중복신Y형수뇨관1례,쌍측수뇨관식육1례,단측수뇨관식육1례,쌍측미주혈관압박1례.1례우술후3d인단측지가관도새이뇨외삼지장동력성강저,술후통과금식급위장감압후자행치유.3례술후24 h후잉유명현육안혈뇨,통과연장지혈약적사용혈뇨소실,무명현고탄산혈증、내배경문란등CO2기복상관병발증,무기타위장동력감약혹궤계성경조병례발생.무ClavienⅢ급수술병발증.술후12개월10례20측(66.7％)획득수방,재20측환신중,10측(50％)신적수완전완해,10측(50％)부분완해.술후24개월14측(70％)획득완전완해,6측(30％)부분완해,무재차수술병례.결론 경제부(2공)화제부여검돌하련선중점(1공)량부위초관천자,복강경하쌍측Anderson-Hynes신우수뇨관성형술치료인동UPJO안전유효,술후효과량호,구유미창우세.
Objective To evaluate the feasibility,safety,efficacy and advantages of simultaneous bilateral laparoscopic Anderson-Hynes pyeloplasty in the treatment of ureteropelvic junction obstruction (UPJO).Methods We retrospectively reviewed 15 patients undergoing simultaneous bilateral laparoscopic Anderson-Hynes pyeloplasty (2 umbilical trocars and 1 trocar placed put in midpointbetween umbilicus and xiphoid process) for UPJO by the same surgeon.The median age was 5 (1-14) years.The clinical manifestations included loin pain (n =7),urinary tract infections (UTI,n =2),bilateral loin mass (n =4),unilateral loin mass (n =4) and giant hydronephrosis (n =2).The follow-up period was 12-24 months.Type B ultrasonography was employed for tracking the severity of hydronephrosis,intravenous urography (IVU) for UPJO when necessary and urinalysis for urinary tract infection.The conversion rate,operative duration,blood loss volume,length of hospitalization,complications,reintervention rate and level of hydronephrosis remission were evaluated.Results All procedures were completed successfully.Neither conversion into open surgery nor extra trocar or incision was required.The operative duration was (180 ±-60) min,blood loss volume (21.6 ± 13.9) ml and length of hospitalization (10.1 ± 2.0) days.Intraoperative observations revealed incomplete ureteral duplication (n =1),bilateral ureteral polyps (n =1),unilateral ureteral polyps (n =1) and bilateral aberrant vessels (n =1).One case of temporary ileus resulted from urinary extravasation through a drainage tube jam without urinary tract infection at Day 3 after procedure.It achieved a remission after fasting and gastrointestinal decompression.Three cases of hematuria at 24 h disappeared when hemostatics was enhanced.Neither hypercapnia nor internal environment disturbance occurred.No reduced gastrointestinal motility or mechanical obstruction complications were observed.There was no occurrence of Clavien Ⅲ complication.Ten (66.7％) cases were followed after 12 months.Among 10 cases,complete and partial remission rate were 50％ (10 kidneys) and 50％ (10 kidneys).At 24 months after procedure,the above ratios were 70 ％ (14 kidneys) and 30％ (6 kidneys) respectively.No secondary surgical intervention was required.Conclusions Simultaneous bilateral laparoscopic Anderson-Hynes pyeloplasty is both safe,mini-invasive and effective with excellent outcomes.