【摘要】 目的探讨经后腹腔镜下"T-Q"三步法离断性肾盂成形术治疗肾盂输尿管连接部梗阻(ureteropelvic junction obstruction,UPJO)的可行性和安全性。方法 2015年1月~2016年1月我科对5例UPJO行"T-Q"三步法离断性肾盂成形术,第1步:在梗阻段远侧0.5 cm处将输尿管剪一"T"形切口,近侧的肾盂剪一"Q"形切口,梗阻段保持半离断并牵引,间断缝合离断面的下缘供对合牵引,置入双J管;第2步:将"T"和"Q"切缘背侧用5-0可吸收线缝合,沿该点将肾盂输尿管后壁吻合,仍"孤岛式"存留半离断的梗阻段病变组织;第3步,缝合肾盂输尿管前壁,切除半离断的梗阻病变组织。结果 5例手术均顺利完成,无术中转开放手术。手术时间60~100 min,平均70 min;估计出血量10~50 ml,平均30 ml。术后1~2 d(平均1.6 d)恢复肠道功能;术后2~4 d(平均2.6 d)拔除引流管。术后住院时间5~8 d,平均6.2 d。5例术后随访6~10个月,4例术前腰痛症状消失,B超检查示3例肾积水由Ⅲ度转为Ⅰ度,1例由Ⅳ度转为Ⅲ度,1例肾积水消失,未见吻合口狭窄、漏尿等并发症。结论后腹腔镜下"T-Q"三步法离断性肾盂成形术治疗UPJO安全、有效,改良术式使手术过程简捷易学,值得推广。更多还原

【Abstract】 Objective To evaluate the feasibility and safety of retroperitoneal laparoscopic " T-Q" three-step procedure for dismembered pyeloplasty in the treatment of ureteropelvic junction obstruction( UPJO). Methods Between January 2015 and January 2016,5 patients with UPJO were selected. The " T-Q " three-step pyeloplasty was performed through retroperitoneal laparoscopy under general anesthesia. The first step was to cut a " T" incision at 0. 5 cm of the distal of the obstruction of ureter,and then to cut a " Q" incision at renal pelvis of the proximal of the obstruction. The obstructed segment half was kept dismembered and under traction,and the lower edge of the dismembered section was interrupted sutured to apply combined traction. And a double-J tube was placed. The second step was to suture the dorsal of the margin of " T" and " Q" with 5-0 absorbable sutures. The posterior wall of renal pelvis and ureter was anastomosed along the point,and the obstructed tissues were still left isolated and semi-transected. The third step was to close the anterior wall of renal pelvis and ureter,and the hemisected obstruction tissue was removed. Results All the surgeries of the 5 patients were completed successfully,and none was converted to open surgery. The operation time was 60-100 min( mean,70 min). The estimated blood loss was 10-50 ml( mean,30 ml). After surgery,the recovery time of intestinal function were 1-2 days( mean,1. 6 days),the drainage tube was removed at 2-4 days( mean,2. 6 days),and the postoperative inpatient time was 4-8 days( mean,6 days). All the patients were followed up for 6-10 months,and symptoms disappeared in 4 cases.Ultrasound examination showed that 3 patients with hydronephrosis from grade Ⅲ to grade Ⅰ,1 case from grade Ⅳ to grade Ⅲ,and disappeared in 1 case. No complications such as anastomotic stenosis or leakages were found. Conclusions The treatment of UPJO by retroperitoneal laparoscopic " T-Q" three-step procedure for dismembered pyeloplasty is safe and effective. The improved operation process is easy to master and is worthy of promoting.更多还原