目的 探讨“输尿管拖出法”在腹腔镜离断式肾盂成形术治疗小儿肾盂输尿管连接部梗阻中的手术技巧,总结该方法的临床应用价值。方法 回顾性分析2015年11月至2016年5月本院收治的15例肾盂输尿管连接部梗阻患儿临床资料,其中男性8例,女性7例,年龄2个月至8岁。因胎儿期发现肾积水出生后随访积水进行性加重8例,因腹痛就诊行超声检查发现肾积水7例。患儿均接受腹腔镜下离断式肾盂成形术,术中采用输尿管拖出法处理病变段。收集手术情况、手术时间、出血量及并发症情况。术后定期门诊超声随访。结果 15例均手术成功,无中转开放手术病例,无留置J管相关并发症。平均手术时间143(116～244)min。平均术中出血量5(2～15)mL。术中留置双J管耗时平均6(3～10)min。术中留置双J管困难,发现输尿管远端狭窄1例。术后平均住院时间7(5～10)d。术后1个月复查超声,提示肾盂积水较术前明显减轻,肾实质厚度稳定。结论 在腹腔镜治疗肾盂输尿管连接部梗阻中采用“输尿管拖出法”处理输尿管,并留置双J管安全可行,有精确触觉反馈,能够提高肾盂输尿管连接部梗阻合并输尿管中、远段病变的检出率,降低手术初学者难度,值得临床推广。
Objective To evaluate the experience and result of the “ureter pulls out technique” in laparoscopic dismembered Anderson-Hynes pyeloplasty. Methods 15 patients(8 males and 7 females)were retrospectively reviewed between November 2015 and May 2016,who had been diagnosed with hydronephrosis and received laparoscopic dismembered Anderson-Hynes pyeloplasty.The operations were carried out under general anaesthesia. During the operation,the “ureter pulls out technique” was employed.The clinical data was recorded,including time consuming,blood lose,length of hospital stay after operation and complication. Results All 15 patients received laparoscopic ureteropyeloplasty,and “ureter pulls out techniques” were employed during operations. All operations went smoothly without conversion record. Average time consuming:143min(range 116～244 min).Blood lose:5 mL(range 2～15 mL). A UVJO case was recorded for the unsuccessful seat of “double J” stent during operation.Average hospital stay length was 7 d(range 5～10 d). Ultrasonography study demonstrated a significantly relieve of hydronephrosis after operation for one month. Conclusion The “ureter pulls out technique” is safe and feasible in laparoscopic dismembered Anderson-Hynes pyeloplasty. The accurate haptic feedback can improve the positive detective ratio of the ureter distal lesion; also improve the accuracy of treating UPJ,reducing the difficulty for beginners. It is worthy of clinical application.
