Comparison of Retroperitoneal Laparoscopy and Open Pyeloplasty for Ureteropelvic Junction Obstruction
- VernacularTitle:后腹腔镜与开放肾盂成形手术的疗效比较
- Author:
Tao HUANG
;
Linyu ZHOU
;
Kui WU
- Publication Type:Journal Article
- Keywords:
Ureteropelvic junction obstruction;
Laparoscopy;
Pyeloplasty
- From:
Chinese Journal of Minimally Invasive Surgery
2005;0(10):-
- CountryChina
- Language:Chinese
-
Abstract:
Objective To compare the efficacy of retroperitoneal laparoscopy with open pyeloplasty for ureteropelvic junction obstruction(UPJO).Methods Retroperitoneal laparoscopy was performed under general anesthesia with the patients placed in lateral position.Three trocars were inserted at the midaxillary line above the iliac crest,and the pre- and post-axillary lines beneath the 12th rib.A fourth port was placed at the preaxillary line above the iliac crest.Over the medial margin of the psoas major,Gerota’s fascia was opened to expose the ureter.And then,the tissues around the ureter were cut to show the lower pole of the kidney.Afterwards,the redundant renal pelvis and the strictured segment of the ureter were resected,pelvi-ureteric anastomosis was completed with absorbable sutures,and a double-J stent was inserted.Open pyeloplasty was also carried out under general anesthesia with the patients in lateral position.An incision was made beneath the 12th rib to expose the ureteropelvic junction,and then the renal pelvis was cut at 2 cm away from the renal parenchyma,and the strictured segment of the ureter was resected.Double-J stent was indwelled after pelvi-ureteric anastomosis.The patient was placed in a lateral position under general anesthesia or epidural anesthesia.Subcostal incision was made.The lower pole of the kidney,the dilated renal pelvis and the upper ureter were mobilized in front of the psoas major.Cut the pelvis 2 cm away from the parenchyma and the PUJ was dismembered.The pelvi-ureteric anastomosis was completed with absorbable sutures and then a D-J stent was inserted.Results Compared with the open surgery group,the laparoscopy group experienced significantly longer operation time [(156.9?69.2) min vs(111.9?78.1) min,t=2.514,P=0.014],but less blood loss [mean:35(20-70)ml vs 110(60-175)ml,t=7.502,P=0.000],and shorter analgesic treatment and postoperative hospital stay [(0.7?0.3) d and(8.5?6.1) d vs(1.3?0.5) d and(15.5?10.8) d;t=-5.842,and -3.193;P=0.000 was found and 0.002].No significant difference in the occurrence of postoperative complications and hydronephrosis between the 2 groups was found [laparoscopy vs open surgery:urinary leakage:3 cases vs 3 cases,?2=0.000,P=1.000;incisional infection:0 vs 1,?2=0.000,P=1.000;and recurrence of UPJO:1 vs 0,?2=0.000,P=1.000;hydronephrosis:?2=5.192,P=0.182].Conclusions The efficacy of retroperitoneal laparoscopic pyeloplasty is comparable to open surgery.The procedure results in less blood loss and quicker recovery.
