三种手术方式治疗肾盂输尿管连接部梗阻的疗效及并发症比较

doi:10.3969/j.issn.1671-167X.2016.05.012

摘要/Abstract

摘要：

目的：探讨开放肾盂成形术、腹腔镜肾盂成形术以及腔内手术治疗肾盂输尿管连接部梗阻（ureteropelvic junction obstruction，UPJO）的疗效，并比较各项相关围手术期数据。方法：回顾性分析2004年1月至2014年12月于北京大学人民医院进行手术的109例UPJO病例，分为开放肾盂成形术组（32例）、腹腔镜肾盂成形术组（31例）和腔内手术组（46例），术后平均随访时间（51.9±40.1）个月（6～132个月）。将各组手术时间、术中出血量、围手术期并发症和术后住院时间等进行统计学分析。结果：全部腹腔镜手术均未中转开腹，全部腔内手术均成功完成。腹腔镜肾盂成形术组手术时间为（195.97±55.22） min，开放肾盂成形术组为（121.19±33.95） min，腔内手术组为（74.04±33.95） min，两两组间比较差异均有统计学意义（P<0.001）。开放肾盂成形术组出血量为105(15,815) mL，腹腔镜肾盂成形术组为50（10,495） mL，两组间差异无统计学意义（P=0.163）；腔内手术组为5（0,310） mL，与其他两组相比差异均有统计学意义（P<0.001）。开放肾盂成形术组术后住院时间为8（5,18） d，腹腔镜肾盂成形术组为7（3,15）d，腔内手术组为6（1，25）d，3组间差异均有统计学意义（P<0.05）。开放肾盂成形术组的成功率（93.8%）与腹腔镜肾盂成形术组（90.3%）间差异无统计学意义（P=0.618），而腔内手术组（69.6%）则低于另外两组（P=0.010，P=0.032）。开放肾盂成形术组、腹腔镜肾盂成形术组、腔内手术组3组的并发症发生率分别为15.6%（5/32）、16.1%（5/31）和13.0%（6/46），两两组间比较差异均无统计学意义（P>0.05）。结论：腹腔镜肾盂成形术和开放肾盂成形术相比手术时间更长，但术后住院时间短于开放肾盂成形术组;腔内手术治疗UPJO的成功率低于开放肾盂成形术和腹腔镜肾盂成形术，但其在手术时间、术中出血量和术后恢复时间方面均有明显优势。

关键词: 肾盂输尿管连接部梗阻, 肾盂成形术, 手术疗效, 并发症

Abstract:

Objective： To compare various data of open pyeloplasty, laparoscopic pyeloplasty and endopyelotomy as a treatment of ureteropelvic junction obstruction（UPJO）, and to investigate and discuss the feasibility and effect of the three methods. Methods: In the study, 109 cases of UPJO treated by different surgical approaches in Peking University People’s Hospital from January 2004 to December 2014 were retrospectively investigated. The patients were divided into three groups according to the treatment they received: open peyloplasty group (32 cases), laparoscopic peyloplasty group (31 cases) and endopyelotomy group (46 cases).We compared the data of the operative time, intraoperative blood loss, perioperative complications and post-operative hospital stay among the three groups. The mean follow-up time was（51.9±40.1） months (6-132 months). Results: None of the laparoscopic peyloplties was converted to open peyloplasty. All endpyelotomies were successfully completed. The operative time was as follows: laparoscopic peyloplasty group (195.97±55.22) min, open peyloplasty group (121.19±33.95) min and endopyelotomy group (74.04±33.95) min，and there were significant differences among the three groups respectively（P<0.001）. There was no significant difference on the operative blood loss between open peyloplasty group and laparoscopic peyloplasty group (P=0.163). The operative blood loss of endopyelotomy group was 5（0,310）mL，which was lower than the other two groups, and this result had significant differences with the other two groups respectively（P<0.001）. There were significant differences on the postoperative hospital stay (days) among open peyloplasty group, laparoscopic peyloplasty group and endopeylotomy group (P<0.05，respectively).The success rate was comparable between open peyloplasty group and laparoscopic peyloplasty group( 93.8% vs. 90.3%, P=0.672), while the endopeylotomy group had a lower success rate compared with both open surgery group and laparoscopic group(69.6% vs. 93.8%, P=0.01； 69.6% vs. 90.3%, P=0.048, respectively). The complication rates of open peyloplasty group, laparoscopic peyloplasty group and endopeylotomy group were comparable(15.6%, 16.1% and 13.0%, respectively, P>0.05). Conclusion: The laparoscopic peyloplasty group had a longer operative time than open peyloplasty group, while its post-operative stay was shorter. There was no significant difference on the operative blood loss between open peyloplasty group and laparoscopic peyloplasty group. Although the success rate of endopyelotomy was lower than those of the other two groups, it had advantages over the aspect of operative time, operative blood loss and post operative stay.

Key words: Ureteropelvic junction obstruction, Pyeloplasty, Operative effect, Complications

中图分类号:

R692.1

陈伟男，叶雄俊，刘士军，熊六林，黄晓波，徐涛，王晓峰. 三种手术方式治疗肾盂输尿管连接部梗阻的疗效及并发症比较[J]. 北京大学学报(医学版), 2016, 48(5): 817-821.

CHEN Wei-nan, YE Xiong-jun, LIU Shi-jun, XIONG Liu-lin, HUANG Xiao-bo, XU Tao, WANG Xiao-feng. Comparison of three surgical methods of ureteropelvic junction obstruction in therapeutic effect and complication[J]. Journal of Peking University(Health Sciences), 2016, 48(5): 817-821.

参考文献

相关文章 15

[1]	万利, 张周沧, 丁嘉祥, 王梅. 中心静脉导管拔除后静脉空气栓塞1例[J]. 北京大学学报（医学版）, 2024, 56(5): 938-941.
[2]	许素环,王蓓蓓,庞秋颖,钟丽君,丁炎明,黄燕波,车新艳. 等体温膀胱冲洗对经尿道前列腺电切术患者干预效果的meta分析[J]. 北京大学学报（医学版）, 2023, 55(4): 676-683.
[3]	李辉,高阳旭,王书磊,姚红新. 恶性肿瘤患儿完全植入式静脉输液港手术并发症[J]. 北京大学学报（医学版）, 2022, 54(6): 1167-1171.
[4]	姜保国,张培训. 老年髋部骨折的围手术期风险评估[J]. 北京大学学报（医学版）, 2022, 54(5): 803-809.
[5]	安立哲,熊六林,陈亮,王焕瑞,陈伟男,黄晓波. 腹腔镜肾盂成形术联合肾盂镜超声碎石取石术治疗肾盂输尿管连接部梗阻合并肾结石[J]. 北京大学学报（医学版）, 2022, 54(4): 746-750.
[6]	于博,赵扬玉,张喆,王永清. 妊娠合并感染性心内膜炎1例[J]. 北京大学学报（医学版）, 2022, 54(3): 578-580.
[7]	吴俊慧,武轶群,吴瑶,王紫荆,吴涛,秦雪英,王梦莹,王小文,王伽婷,胡永华. 北京城镇职工2型糖尿病患者缺血性脑卒中发病率及主要危险因素[J]. 北京大学学报（医学版）, 2022, 54(2): 249-254.
[8]	李伟浩,李伟,张学民,李清乐,焦洋,张韬,蒋京军,张小明. 去分支杂交手术和传统手术治疗胸腹主动脉瘤的结果比较[J]. 北京大学学报（医学版）, 2022, 54(1): 177-181.
[9]	王成,孟令宇,陈拿云,李玳,王健全,敖英芳. 前交叉韧带重建术后膝关节感染的诊断和治疗策略[J]. 北京大学学报（医学版）, 2021, 53(5): 850-856.
[10]	耿志宇,高为华,王东信. 全身麻醉气管插管患者术后声带运动不良的临床结局[J]. 北京大学学报（医学版）, 2021, 53(2): 337-340.
[11]	董文敏,王明瑞,胡浩,王起,许克新,徐涛. Allium覆膜金属输尿管支架长期留置治疗输尿管-回肠吻合口狭窄的初期临床经验及随访结果[J]. 北京大学学报（医学版）, 2020, 52(4): 637-641.
[12]	高健,胡立宝,陈尘,郅新,徐涛. 经皮肾镜去石术后出血的介入治疗[J]. 北京大学学报（医学版）, 2020, 52(4): 667-671.
[13]	郑蒙蒙,丁光璞,朱伟杰,杨昆霖,樊书菠,关豹,李新飞,蔡宇坤,张进生,李学松,周利群. 术前三维影像重建在治疗肾盂输尿管连接部梗阻中的应用[J]. 北京大学学报（医学版）, 2020, 52(4): 705-710.
[14]	熊盛炜,王杰,朱伟杰,程嗣达,张雷,李学松,周利群. 二次肾盂成形术在复发性肾盂输尿管连接部梗阻中的研究进展[J]. 北京大学学报（医学版）, 2020, 52(4): 794-798.
[15]	马凯,曲星珂,许清泉,熊六林,叶雄俊,安立哲,陈伟男,黄晓波. 肾移植术后移植肾输尿管膀胱吻合口狭窄的腔内治疗:13例报道[J]. 北京大学学报（医学版）, 2019, 51(6): 1155-1158.

Metrics

Viewed

Full text

Abstract

Cited

Shared

Discussed