Laparoscopic modified bypass pyeloplasty: a simple procedure for straightforward ureteral spatulation and intracorporeal suturing
Laparoscopic modified bypass pyeloplasty: a simple procedure for straightforward ureteral spatulation and intracorporeal suturing
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腹腔镜改良旁路肾盂成形术：直接输尿管切开和体内缝合的简单手术
DOI：
10.1007/s11255-015-1123-9
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发表时间：
2015
影响因子：
2
通讯作者：
Kojima Y
中科院分区：
文献类型：
--
作者：
Haga N;Sato Y;Ogawa S;Yabe M;Akaihata H;Hata J;Ishibashi K;Mizuno K;Hayashi Y;Kojima Y
目的旁路肾盂成形术（BP）是一种简单、不离断肾盂输尿管连接部（UPJ）的侧侧吻合术。BP被认为比通过腹腔镜途径的离断肾盂成形术更适合于新手外科医生，但未报道。但是，腹腔镜BP的缺点是很难缝合吻合口远离摄像机的一侧。为了克服这个缺点，开发了一种改进的技术。这个程序及其初步结果reported.MethodsTwenty-six连续患者接受腹腔镜改良BP。患者手术时的中位年龄为10.5岁。10例患者为成人，16例为儿童。改良BP术的关键步骤是切开输尿管后分离UPJ并缝合其依赖部分。这提供了更好的可视化的吻合部分和容易anastomo.ResultsAll程序完成了腹腔镜改良BP。中位手术时间为246（范围170-357）min。肾盂输尿管吻合的中位时间为205（范围145-311）min。成人和儿童的平均手术时间和肾盂输尿管吻合时间无显著差异（成人/儿童分别为243 ± 49 min：252 ± 58 min，p= 0.66; 192 ± 33 min：214 ± 48 min，p= 0.21）。UPJO的成功解决观察cases.ConclusionsLaparoscopic改良BP结合了非离断和离断肾盂成形术的优点。由于成人和儿童的平均手术和吻合时间没有差异，腹腔镜改良BP可能是所有年龄段的有效手术，尤其是儿童。
PurposeBypass pyeloplasty (BP) is a simple, non-dismembered procedure that is a side-to-side anastomosis without dividing the ureteropelvic junction (UPJ). BP has been considered more suitable especially for novice surgeons than dismembered pyeloplasty via the laparoscopic approach, but not reported. However, the disadvantage of laparoscopic BP is that it is difficult to suture the side of the anastomosis that is far from the camera. To overcome this disadvantage, a modified technique was developed. This procedure and its initial results are reported.MethodsTwenty-six consecutive patients underwent laparoscopic modified BP. The patients’ median age at surgery was 10.5 years. Ten patients were adults and 16 were children. The key step of modified BP involves dividing the UPJ after ureteral spatulation and suture of the dependent portion. This provides both better visualization of the anastomosis portion and easy anastomosis.ResultsAll procedures were completed by laparoscopic modified BP. The median operative time was 246 (range 170–357) min. The median time for ureteropelvic anastomosis was 205 (range 145–311) min. There were no significant differences in mean operative time and ureteropelvic anastomotic time between adults and children (adults/children = 243 ± 49 min:252 ± 58 min,p= 0.66, 192 ± 33 min:214 ± 48 min,p= 0.21, respectively). Successful resolution of UPJO was observed in 96 % of cases.ConclusionsLaparoscopic modified BP combines the advantages of non-dismembered and dismembered pyeloplasty. Because there were no differences in mean operative and anastomotic times between adults and children, laparoscopic modified BP might be an efficient procedure for all ages, especially children.