【摘要】 目的：研究层面解剖技术在腹腔镜下肾盂输尿管连接处(UPJ)成形术中的临床应用效果。方法：回顾分析新余市人民医院2015年3月-2022年1月收治的87例UPJ畸形患者的临床资料，根据手术方式的不同进行分组，其中36例患者采用传统开放手术，将其归为对照组，51例患者在腹腔镜下UPJ成形术中应用层面解剖技术，将其归为观察组。比较两组术中基本情况(术中出血量、手术时间)、术后恢复情况(术后拔除引流管时间、术后下床活动时间、术后肛门恢复排气时间、术后住院时间)；比较两组术后3、6、12 h腹部疼痛评分[视觉模拟评分法(VAS)]，统计术后3 d内两组并发症发生率。结果：观察组术中出血量为(85.72±15.86)mL，低于对照组(94.15±16.97)mL，差异有统计学意义(t=2.372，P=0.020)。观察组手术时间为(3.43±0.88)h，短于对照组的(4.12±0.79)h，差异有统计学意义(t=3.755，P<0.001)。观察组术后拔除引流管时间为(3.82±0.36)d，短于对照组(5.03±0.41)d，差异有统计学意义(t=2.529，P=0.013)。观察组术后下床活动时间为(1.38±0.37)d，短于对照组的(1.56±0.34)d，差异有统计学意义(t=2.310，P=0.023)。观察组术后肛门恢复排气时间为(1.45±0.39)d，短于对照组(1.62±0.36)d，差异有统计学意义(t=2.066，P=0.042)。观察组术后住院时间为(8.81±1.50)d，短于对照组(10.56±1.53)d，差异有统计学意义(t=5.315，P<0.001)。观察组术后6 h腹部VAS评分为(1.85±0.41)分，低于对照组的(2.06±0.50)分，差异有统计学意义(t=2.147，P=0.035)。观察组术后12 h腹部VAS评分为(2.28±0.56)分，低于对照组(2.59±0.51)分，差异有统计学意义(t=2.637，P=0.010)。术后3 d内，观察组并发症发生率为3.92%，低于对照组的19.44%，差异有统计学意义(χ~2=3.936，P=0.047)。结论：在腹腔镜下UPJ成形术中应用层面解剖技术相比于传统开放手术，术中出血量更少、手术时间更短，术后恢复更快，其疼痛程度更低，并能降低并发症的发生，值得临床应用推广。更多还原

【Abstract】 Objective:To study the clinical application effect of slice anatomical technique during laparoscopic ureteropelvic junction (UPJ) plasty.Method:The clinical data of 87 patients with UPJ deformity who were treated in Xinyu People’s Hospital from March 2015 to January 2022 were retrospective analyzed,according to the different surgical methods,36 patients underwent traditional open surgery were classified as the control group,while 51 patients underwent slice anatomical technique during laparoscopic UPJ plasty were classified as the observation group.The basic intraoperative information (intraoperative blood loss,surgical time),postoperative recovery (postoperative drainage tube removal time,postoperative ambulation time,postoperative anal exhaust recovery time,postoperative hospital stay) were compared between two groups;abdominal pain scores[visual analogue scale (VAS)]at 3,6 and 12 h after surgery were compared between two groups;the incidence of complications in the two groups within 3 d after surgery was calculated.Result:Intraoperative blood loss in the observation group was (85.72±15.86) mL,which was less than (94.15±16.97) mL in the control group,the difference was statistically significant (t=2.372,P=0.020).Surgical time in the observation group was (3.43±0.88) h,which was shorter than (4.12±0.79) h in the control group,the difference was statistically significant (t=3.755,P<0.001).Postoperative drainage tube removal time in the observation group was (3.82±0.36) d,which was shorter than (5.03±0.41) d in the control group,the difference was statistically significant (t=2.529,P=0.013).Postoperative ambulation time in the observation group was (1.38±0.37) d,which was shorter than (1.56±0.34) d in the control group,the difference was statistically significant (t=2.310,P=0.023).Postoperative anal exhaust recovery time in the observation group was (1.45±0.39) d,which was shorter than (1.62±0.36) d in the control group,the difference was statistically significant (t=2.066,P=0.042).Postoperative hospital stay in the observation group was (8.81±1.50) d,which was shorter than (10.56±1.53) d in the control group,and the difference was statistically significant (t=5.315,P<0.001).Abdominal VAS score at 6 h after surgery in the observation group was (1.85±0.41) points,which was lower than (2.06±0.50) points in the control group,the difference was statistically significant (t=2.147,P=0.035).Abdominal VAS score at 12 h after surgery in the observation group was (2.28±0.56) points,which was lower than (2.59±0.51) points in the control group,the difference was statistically significant (t=2.637,P=0.010).Within 3 d after surgery,the incidence of complications was 3.92% in the observation group,which was lower than 19.44% in the control group,the difference was statistically significant (χ~2=3.936,P=0.047).Conclusion:Compared with traditional open surgery,slice anatomical technique during laparoscopic UPJ plasty has less intraoperative blood loss,shorter surgical time,faster postoperative recovery and milder pain degree,and the latter one can reduce the occurrence of complications,therefore it is worthy of clinical application and promotion.更多还原