颜冰 孙毅海 黄恒前

[摘要]目的 比較经腹膜后腹腔镜手术和开放手术治疗肾盂输尿管连接部梗阻（UPJO）的效果，并探讨经腹膜后腹腔镜手术应注意的问题。方法 选取2014年1月～2019年6月我院收治的106例单侧UPJO患者为研究对象，按照随机抽签分组方法分为观察组（53例）和对照组（53例）。观察组采用经腹膜后腹腔镜下离断肾盂成形术，对照组采用经腹膜后开放性离断肾盂成形术。比较两组的手术切口长度、手术时间、术中出血量、中转开放手术、术后肠功能恢复时间、术后下床活动时间、术后住院时间、术后并发症、术后疗效。结果 观察组的手术切口长度短于对照组，术中出血量少于对照组，术后肠功能恢复时间、术后下床时间和术后住院时间均短于对照组，差异有统计学意义（P<0.01）;两组的手术时间、中转开放手术、术后并发症和术后疗效比较，差异无统计学意义（P>0.05）。结论 经腹膜后腹腔镜离断肾盂成形术治疗UPJO具有微创、出血少、术后康复快等优点，较开放手术更有优势，值得临床推广应用。

[关键词]肾盂输尿管连接部梗阻;经腹膜后腹腔镜手术;经腹膜后开放性手术;离断肾盂成形术

[中图分类号] R693+.2          [文献标识码] A          [文章编号] 1674-4721（2020）6（b）-0032-04

[Abstract] Objective To compare the efficacies of retroperitoneal laparoscopic surgery and open operation in the treatment of ureteropelvic junction obstruction （UPJO）， and to discuss the problems that should be paid attention to in retroperitoneal laparoscopic surgery. Methods A total of 106 patients with unilateral UPJO from January 2014 to June 2019 were selected as the study object， they were divided into the observation group （53 cases） and the control group （53 cases） according to the method of random drawing. The observation group underwent retroperitoneal laparoscopic pyeloplasty， the control group underwent open pyeloplasty. Incision length， operation time， intraoperative bleeding volume， conversion to the open surgery intraoperatively， postoperative recovery time of bowel function， time of postoperative ground activity， length of postoperative hospitalization， postoperative complications， postoperative efficacy were compared between the two groups. Results The incision length in the observation group was shorter than that in the control group， the intraoperative bleeding volume in the observation group was less than that in the control group， the postoperative recovery of bowel function， time of postoperative ground activity and length of postoperative hospital stay of the observation group were shorter than those of the control group， there were significant difference （P<0.01）. The differences of operation time， conversion to the open surgery intraoperatively， postoperative complications and postoperative efficacy between two groups were not statistically significant （P>0.05）. Conclusion Compared with the open surgery， retroperitoneal laparoscopic pyeloplasty for UPJO has the advantages of minimally invasive， less bleeding and quick postoperative recovery， it is worthy of clinical promotion and application.

[Key words] Ureteropelvic junction obstruction; Retroperitoneal laparoscopic surgery; Retroperitoneal open surgery; Dismembered pyeloplasty

肾盂输尿管连接部梗阻（ureteropelvic junction obstruction，UPJO）是肾积液常见的重要原因之一，如不处理，可引起肾盂内压逐渐增高、肾积液加重，进而导致肾脏不可逆的损伤。UPJO的治疗方法以手术为主，手术多采用开放性离断式肾盂成形术，术后梗阻可解除，能够恢复肾盂输尿管再通畅，改善临床症状，减轻肾积液，恢复肾功能，是治疗UPJO的“金标准”[1]。……