【摘要】 目的:探讨改良腹腔镜离断式肾盂输尿管成形术治疗儿童肾积水的疗效。方法:回顾分析2007年8月至2010年9月为23例患儿行改良腹腔镜离断式肾盂输尿管成形术的临床资料。结果:23例均完成腹腔镜手术,无一例中转开腹。手术时间100~160min,平均126min;术中出血10~24ml,平均14ml;术后住院4~7d,平均5.5d;术后均无腹腔感染及肠粘连发生,切口乙级愈合2例;1例肾周引流尿液约100ml/d,术后3d消失;术后6个月复查CT,中度肾积水2肾(集合系统分离1~1.2cm),轻度肾积水5肾(集合系统分离小于1cm),其余均无明显肾积水,肾皮质变薄者明显改善。结论:腹腔镜间断加连续吻合重建肾盂输尿管治疗儿童肾积水是一种较好的术式,可用于替代单纯的间断吻合。更多还原

【Abstract】 Objective:To investigate the therapeutic effect of transperitoneal laparoscopic dismembered pyeloplasty with modified anastomosis on children with hydronephrosis.Methods:For the reconstruction of ureter pelvic junction,simple interrupted anastomosis was substituted for interrupted and continuous anastomosis.Remaining the connection of the inside wall between the ureter and the renal pelvis,the lateral of the spatulated ureter was anastomosed to the caudally reflected renal pelvis using an interrupted suture for 3 stitches,and then the posterior wall was continuously anastomosed and then a double-J tube was placed.The obstructed ureteropelvic junction was then excised and the renal pelvis was trimmed.The remaining anterior half of the anastomosis was then completed with continuous anastomosis.The group using the new method of anastomosis was compared with the group using the simple interrupted anastomosis.Results:The operations were successful in all 23 cases by transperitoneal laparoscopic dismembered pyeloplasty,without conversion to open surgery.The operative time was 100-160min(mean,126min),the blood loss was 10-24ml with a mean of 14ml,none blood transfusion necessitated;the postoperative hospitalization was 4-7 days with a mean of 5.5 days;there was no serious complications found,such as intra-abdominal infection or intestinal adhesion;mere 2 patients were class-B healing;the perinephric urine drainage occurred in only 1 patient with 100ml/d,and disappeared 3 days after operation;the patients were examined with CT 6 months after operation,intermediate hydronephrosis in 2 individual kidneys(collecting systems separated from 1-1.2cm),mild in 5 individual kidneys(collecting systems separated less than 1cm) and resolution in others;the previous thinned renal cortex was significantly thickened.Conclusions:The interrupted and continuous anastomoses for the reconstruction of ureteropelvic junction on children with hydronephrosis have less operative time than the simple interrupted anastomosis for dismembered pyeloplasty.The blood loss,postoperative complications and therapeutic effect have no significant differences.更多还原