经皮顺行腔内切开术治疗肾盂输尿管连接部梗阻

胡卫国; 李建兴; 杨波; 黄晓波; 王晓峰

经皮顺行腔内切开术治疗肾盂输尿管连接部梗阻

- 北京大学人民医院泌尿外科(北京, 100044)

详细信息

通讯作者: 李建兴,E-mail:ljx1@sina.com

中图分类号: R693.2

收稿日期: 2011-05-19

Treatment of ureteropelvic junction obstruction with percutaneous endopyelotomy

- Department of Urology, People's Hospital, Peking University, Beijing, 100044, China

More Information

Corresponding author: LI Jianxing, E-mail: ljx1@sina.com

Received Date: 19 May 2011

摘要

摘要: 目的:探讨应用经皮顺行腔内切开术(PAE)治疗肾盂输尿管连接部梗阻(UPJO)的适应症、疗效及技巧。方法:UPJO患者75例,其中肾盂输尿管连接部(UPJ)闭锁26例(34.7%)。男38例,女37例,平均年龄35(21~68)岁。左侧31例,右侧44例。原发性UPJO 39例(合并结石37例),开放UPJO成形术后8例,腹腔镜UPJO成形术后4例,开放手术取石术后14例,PCNL术后10例。均经B超、KUB、IVU、CT、逆行肾盂造影检查确诊。结果:Ⅰ期成功内切开69例(92.0%),4例(5.3%)间隔1周后Ⅱ期手术成功,2例放弃Ⅱ期治疗。单一应用PAE 59例(80.8%),PAE联合输尿管镜逆行内切开14例(19.2%)。术后3~6个月拔除输尿管支架管,随访6个月时,62例(84.9%)无复发,复发患者11例(15.1%)中包括UPJ闭锁患者10例。随访12个月时,55例(75.3%)无复发,24个月时52例(71.2%)无复发。21例复发患者中,9例行第二次PAE手术治愈,2例行第三次PAE手术后治愈,1例行开放肾盂成形术,9例每3~6个月更换双J管或动态观察。结论:PAE可以作为原发性UPJO的一线治疗。继发性UPJO或其他成形术后再狭窄的UPJO复发率高,但是PAE适用范围广,可重复性好,仍然是微创腔内治疗的有效手段。
- 肾盂输尿管连接部梗阻 /
- 内窥镜术 /
- 手术
Abstract: Objective:To evaluate the clinical efficacy of percutaneous endopyelotomy (PAE) in the minimally invasive treatment of ureteropelvic junction obstruction (UPJO). Method:Between June 2003 and August 2010, 75 patients of UPJO had undergone PAE. Clinical data were analyzed retrospectively. Success was defined as both radiographic and symptomatic improvement.Result:Sixty-nine(92.0%) patients were operated in one session of PAE, and 4 needed second session of PAE, 2 abandoned further treatment. Single PAE operations were performed in 59(80.8%) patients. Combined antegrade and retrograde endopyelotomy were performed in 14(19.2%) patients. 65 patients were treated by electrocautery endopyelotomy, 5 by holmium laser, 3 by cold knife. The estimated 6 months, 12 months, and 24 months recurrence-free survival rates for the endopyelotomy group were 84.9%, 75.3%, and 71.2%, respectively. Conclusion:PAE is effective for treatment of UPJO, while the recurrence rate for secondary UPJO and those failed other treatment modality is high.
- percutaneous antegrade endopyelotomy /
- ureteropelvic junction obstruction /
- surgical management

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参考文献(5)

[1]	OST M C,KAYE J D,GUTTMAN M J,et al.Laparoscopic pyeloplasty versus antegrade endopy-elotomy:comparison in 100patients and a new algo-rithm for the minimally invasive treatment of uretero-pelvic junction obstruction[J].Urology,2005,66:47-51.
[2]	刘永达,袁坚.金属网状支架在继发性肾盂输尿管连接部梗阻中的应用[J].中华泌尿外科杂志,2004,25(8):554-556.
[3]	DIMARCO D S,GETTMAN M T,MCGEE S M,etal.Long-term success of antegrade endopyelotomycompared with pyeloplasty at a single institution[J].J Endourol,2006,20:707-712.
[4]	RUKIN N J,ASHDOWN D A,PATEL P,et al.The role of percutaneous endopyelotomy for uretero-pelvic junction obstruction[J].Ann R Coll Surg En-gl,2007,89:153-156.
[5]	ZELTSER I S,LIU J B,BAGLEY D H.The inci-dence of crossing vessels in patients with normal ure-teropelvic junction examined with endoluminal ultra-sound[J].J Urol,2004,172:2304-2307.