[1]翟振兴,尚攀峰**,张骕,等.腹腔镜经腹腔与后腹腔途径治疗肾盂输尿管连接部梗阻的比较[J].中国微创外科杂志,2018,18(5):405-408.
　Zhai Zhenxing,Shang Panfeng,Zhang Su,et al.Comparison of Laparoscopic Retroperitoneal and Peritoneal Approaches in the Treatment of Ureteropelvic Junction Obstruction[J].Chinese Journal of Minimally Invasive Surgery,2018,18(5):405-408.
点击复制

腹腔镜经腹腔与后腹腔途径治疗肾盂输尿管连接部梗阻的比较()
分享到：

《中国微创外科杂志》[ISSN:1009-6604/CN:11-4526/R]

卷:
18
期数:
2018年5期
页码:
405-408
栏目:
临床研究
出版日期:
2018-09-04

文章信息/Info

Title:
Comparison of Laparoscopic Retroperitoneal and Peritoneal Approaches in the Treatment of Ureteropelvic Junction Obstruction
作者:
翟振兴; 尚攀峰**; 张骕; 岳中瑾; 王家吉; 王志平; 杨立; 侯子珍; 吴恭瑾; 包军胜; 杨宁强; 张旭东①
兰州大学第二医院泌尿外科，兰州730030
Author(s):
Zhai Zhenxing;  Shang Panfeng;  Zhang Su;  et al.
Department of Urology, Lanzhou University Second Hospital, Lanzhou 730030, China
关键词:
腹腔镜; 后腹腔; 肾盂成形术; 肾盂输尿管连接部梗阻
Keywords:
Laparoscope; Retroperitoneum; Pyeloplasty; Ureteropelvic junction obstruction
文献标志码:
A
摘要:
目的比较腹腔镜经腹腔与后腹腔途径治疗肾盂输尿管连接部梗阻（ureteropelvic junction obstruction，UPJO）的疗效。方法回顾性分析2011年6月~2015年5月98例UPJO的临床资料，其中腹腔组42例，后腹腔组56例，比较2组缝合时间、手术时间、中转开放手术、出血量、住院时间、并发症等方面情况。结果腹腔组缝合时间（57.6±3.6）min，明显短于后腹腔组（65.3±3.5）min（t=-10.647，P=0.000）；腹腔组手术时间（139.7±10.6）min，明显短于后腹腔组（175.3±15.0）min（t=-13.113，P=0.000）；腹腔组术后进食时间（3.7±0.8）d，明显长于后腹腔组（2.3±0.6） d （t=9.904，P=0000）。腹腔组、后腹腔组术后住院时间分别为（8.8±2.6）、（9.2±2.7）d，无统计学差异（t=-0.737，P=0.463）；术中出血量分别为（38.9±8.1）ml、（37.3±7.4）ml，无统计学差异（t=1.589，P=0.115）；2组中转开放手术率分别为2.4%（1/42）、36%（2/56），无统计学差异（χ2=0.000，P=1.000）。结论腹腔镜下肾盂成形术经腹腔途径缝合时间更快，手术时间更短，2种途径治疗UPJO均具有较高的成功率和较少的并发症，手术途径的选择应取决于医生的喜好、经验以及患者的病情。
Abstract:
ObjectiveTo compare the efficacy of laparoscopic retroperitoneal versus transperitoneal pyeloplasty for ureteropelvic junction obstruction(UPJO).MethodsFrom June 2011 to May 2015, there were 98 patients with UPJO, including 42 patients who underwent transperitoneal laparoscopic pyeloplasty (peritoneal group) and 56 patients who underwent retroperitoneal laparoscopic pyeloplasty (retroperitoneal group). The differences between the two groups in the intracorporeal suturion time, operation time, conversion rate, amount of bleeding, hospitalization time and complications were compared.ResultsThe intracorporeal suturing time was shorter in the peritoneal group (57.6±3.6) min than that in the retroperitoneal group ［(65.3±3.5) min, t=-10.467, P=0.000］. The total operation time was shorter in the peritoneal group (139.7±10.6) min than that in the retroperitoneal group ［(175.3±15.0) min, t=-13.113, P=0.000］. But the postoperative feeding time was longer in the peritoneal group (3.7±0.8) d than that in the retroperitoneal group ［(23±0.6) d, t=9.904, P=0.000］. The hospitalization time of the peritoneal group and retroperitoneal group was (8.8±2.6) d and (9.2±2.7) d, respectively, with no significant difference between the two groups (t=-0.737, P=0.463). The amount of bleeding of the peritoneal group and retroperitoneal group was (38.9±8.1) ml and (37.3±7.4) ml, respectively, without significant difference (t=1.589, P=0.115). The conversion rates of the peritoneal group and retroperitoneal group were 2.4% (1/42) and 3.6% (2/56), respectively, without significant difference (χ2=0.000, P=1.000).ConclusionTransperitioneal laparoscopic pyeloplasty is associated with significantly shorter operation time and intracorporeal suturing time in comparison with retroperitoneal laparoscopic pyeloplasty. Both approaches have a high success rate and a low complication rate. The choice of approaches should depend on the doctor’s preferences, experience, and patient’s conditions.

参考文献/References:

[1]Rivas JG, Gregorio SA, Sanchez LC, et al. Evolution in the treatment of the ureteropelvic junction obstruction syndrome. Laparoscopic versus open pyeloplasty. Cent Eur J Urol, 2015,68(3):384-388.
[2]Davenport K, Minervini A, Timoney AG, et al. Our experience with retroperitoneal and transperitoneal laparoscopic pyeloplasty for pelviureteric junction obstruction. Eur Urol,2005,48(6):973-977.
[3]刘磊,马潞林,侯小飞,等.后腹腔镜肾盂成形术技术改进.中国微创外科杂志,2016,16(10):903-906.
[4]Qadri SJ, Khan M. Retroperitoneal versus transperitoneal laparoscopic pyeloplasty: our experience. Urol Int,2010,85(3):309-313.
[5]田晓军,刘茁,马潞林,等.3D 高清腹腔镜系统在泌尿外科手术中的应用.中国微创外科杂志,2016,16(11):990-993.
[6]Turra F, Escolino M, Farina A, et al. Pyeloplasty techniques using minimally invasive surgery (MIS) in pediatric patients. Transl Pediatr,2016,5(4):251-255.
[7]Singh V, Sinha RJ, Gupta DK, et al. Prospective randomized comparison between transperitoneal laparoscopic pyeloplasty and retroperitoneoscopic pyeloplasty for primary ureteropelvic junction obstruction. JSLS,2014,18(3):1-7.
[8]Wu Y, Dong Q, Han P, et al. Metaanalysis of transperitoneal versus retroperitoneal approaches of laparoscopic pyeloplasty for ureteropelvic junction obstruction. J Laparoendosc Adv Surg Tech A,2012,22(7): 658-662.
[9]Schwentner C, Pelzer A, Neururer R, et al. Robotic AndersonHynes pyeloplasty: 5year experience of one centre. BJU Int,2007,100(4):880-885.
[10]Andreoni C, Paiva C, Sabino L, et al. Laparoscopic cholangiogramguide device applied for intracorporeal antegrade ureteric stenting during laparoscopic pyeloplasty. BJU Int,2005,96(7):1139-1141.
[11]Wu Z, Yu J, Qi F, et al. Novel method for doubleJ stenting in retroperitoneal laparoscopic dismembered pyeloplasty. Urology, 2011,77(2):354-356.
[12]Zhu H, Shen C, Li X, et al. Laparoscopic pyeloplasty: a comparison between the transperitoneal and retroperitoneal approach during the learning curve. Urol Int,2013,90(2):130-135.
[13]Shoma AM, El Nahas AR, Bazeed MA. Laparoscopic pyeloplasty: a prospective randomized comparison between the transperitoneal approach and retroperitoneoscopy. J Urol,2007,178(5):2020-2024.
[14]Abuanz S, Game X, Roche JB, et al. Laparoscopic pyeloplasty: comparison between retroperitoneoscopic and transperitoneal approach. Urology,2010,76(4):877-881.

备注/Memo

备注/Memo:
基金项目：国家自然科学基金资助项目 （No.81402122）；中央高校基本科研业务费专项基金（lzujbky-2015-46）；甘肃省卫生行业科研计划项目（GSWSKY2016-11）**通讯作者，E-mail: shangpf@lzu.edu.cn①（武警甘肃总队医院急诊科，兰州730050）
更新日期/Last Update: 2018-09-04