基于“输尿管板”概念的非离断成形术在肾盂输尿管连接部狭窄修复重建中的应用

蒋庆耀; 周亮; 叶冬晖; 简钟宇; 廖邦华; 王坤杰; 李虹

doi:10.13201/j.issn.1001-1420.2020.08.002

基于“输尿管板”概念的非离断成形术在肾盂输尿管连接部狭窄修复重建中的应用

- 四川大学华西医院泌尿外科/华西医院泌尿外科研究所(泌尿系修复与重建研究室)(成都, 610000)

详细信息

通讯作者: 王坤杰,E-mail:wangkj@scu.edu.cn

中图分类号: R693

收稿日期: 2020-06-12

Application of non-dismembered pyeloplasty based on the concept of “ureteral plate” in the reconstruction of ureteropelvic junction obstruction

- Department of Urology, Institute of Urology(Laboratory of Reconstructive Urology), West China Hospital, Sichuan University, Chengdu, 610000, China

More Information

Corresponding author: WANG Kunjie, E-mail: wangkj@scu.edu.cn

Received Date: 12 June 2020

摘要

摘要: 目的:探讨基于“输尿管板”概念的非离断成形术在肾盂输尿管连接部狭窄修复重建中的疗效与安全性。方法:回顾分析2018年3月~2019年12月我院泌尿外科25例接受肾盂成形术的肾盂输尿管连接部狭窄患者。术中均采用非离断式输尿管板技术,成形重建宽大的漏斗状肾盂输尿管连接部。搜集患者的一般临床特征、围术期变量,跟踪随访患者术后症状、影像学检查及实验室结果。结果:共计纳入患者25例,无症状患者8例。平均年龄(28.7±10.0)岁,平均BMI为22.5±3.5。术前血清肌酐平均值(9.9±21.7)μmol/L,患侧分肾功能eGFR(39.6±18.8) mL/min,术前肾盂积水最大径线平均为(4.3±1.2) cm。机器人手术成形5例,其余为开放手术。平均狭窄长度为(1.1±0.5) cm,平均手术时间为(105.7±27.8)min。术后平均住院天数(7.7±1.4) d。围术期均无出血并发症、无发热。仅1例患者术后3 d内每日引流超过100 mL,保守观察后好转。术后血清肌酐平均(77.6±26.9)μmol/L。拔除支架后随访时间为3~24个月。拔管后3个月时1例失访,24例患者术后平均肾积水最大径线(3.0±1.1) cm,治疗有效23例,成功率95.8%。拔管后随访超6个月患者22例,治疗有效21例,成功率95.5%。拔管后随访超12个月患者12例,均为治疗有效。结论:非离断式输尿管板技术治疗肾盂输尿管连接部狭窄的可操作性强,安全性好,疗效可靠。
- 输尿管板 /
- 肾盂输尿管连接部狭窄 /
- 肾盂成形术
Abstract: Objective: To elucidate the efficacy and safety of non-dismembered pyeloplasty based on the concept of "ureteral plate" in the reconstruction of ureteropelvic junction obstruction. Method: The clinical data of 25 patients with ureteropelvic junction obstruction admitted to West China Hospital in recent two years were retrospectively analyzed. A capacious infundibular ureteropelvic junction was reconstructed using the non-dismembered ureteral plate forming technique in pyeloplasty of all the patients. General clinical characteristics and perioperative variables of the patients were collected, and postoperative symptoms, imaging examinations and laboratory examinations were followed up. Result: A total of 25 patients were included and 8 patients were asymptomatic. The average age was(28.7±10.0) years old, and the average BMI was 22.5±3.5. Preoperative mean serum creatinine was(79.9±21.7) μmol/L, renal EGFR of the affected side was(39.6±18.8) mL/min, and preoperative average hydronephrosis was(4.3±1.2) cm. Five patients underwent robotic surgery, the remaining 20 underwent open surgery. The mean length of obstruction was(1.1±0.5) cm, and the mean operation time was(105.7±27.8) min. The average postoperative length of stay was(7.7±1.4) days. There were no serious bleeding complications or postoperative fever during the perioperative period. Only 1 patient was found daily drainage of more than 100 ml within 3 days after surgery, which improved after conservative observation. Postoperative serum creatinine averaged(77.6±26.9) μmol/L. The follow-up time after stent removal was 3-24 months. Three months after stent removal, 1 patient was lost to follow-up. Twenty-four patients had average postoperative hydronephrosis of(3.0±1.1) cm. Twenty-three patients were treated effectively, and the effective rate was 95.8%. There were 22 patients who were followed up for more than 6 months after stent removal, but one patient wasn't effective. The effective rate was 95.5%. Twelve patients were followed up for more than 12 months after stent removal, and they were all effective.Conclusion: The technique of non-dismembered ureteral plate forming in the treatment of ureteropelvic junction obstruction is feasible, safe and effective.
- ureteral plate /
- ureteropelvic junction obstruction /
- pyeloplasty

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