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中华腔镜泌尿外科杂志(电子版) ›› 2023, Vol. 17 ›› Issue (06) : 597 -600. doi: 10.3877/cma.j.issn.1674-3253.2023.06.010

临床研究

经腹入路3D腹腔镜联合输尿管硬镜同期处理肾盂输尿管连接部梗阻并肾盏结石的应用
汪帮琦, 陈波特, 林浩坚, 许晖阳, 王镇伟, 袁雪峰, 林康健, 邱晓拂()   
  1. 510317 广州,广东省第二人民医院(广东省应急医院)泌尿外科
  • 收稿日期:2023-02-08 出版日期:2023-12-01
  • 通信作者: 邱晓拂
  • 基金资助:
    广东省自然科学基金(2018A030313905); 广州市科技计划项目(201904010035)

Application of laparoscopic pyeloplasty combined with ureteroscopy in the treatment of ureteropelvic junction obstruction complicated with calyx calculi

Bangqi Wang, Bote Chen, Haojian Lin, Huiyang Xu, Zhenwei Wang, Xuefeng Yuan, Kangjian Lin, Xiaofu Qiu()   

  1. Department of Urology, Guangdong Second Provincial General Hosptial (Guangdong Provincial Emergency Hospital), Guangzhou, 510317, China
  • Received:2023-02-08 Published:2023-12-01
  • Corresponding author: Xiaofu Qiu
引用本文:

汪帮琦, 陈波特, 林浩坚, 许晖阳, 王镇伟, 袁雪峰, 林康健, 邱晓拂. 经腹入路3D腹腔镜联合输尿管硬镜同期处理肾盂输尿管连接部梗阻并肾盏结石的应用[J]. 中华腔镜泌尿外科杂志(电子版), 2023, 17(06): 597-600.

Bangqi Wang, Bote Chen, Haojian Lin, Huiyang Xu, Zhenwei Wang, Xuefeng Yuan, Kangjian Lin, Xiaofu Qiu. Application of laparoscopic pyeloplasty combined with ureteroscopy in the treatment of ureteropelvic junction obstruction complicated with calyx calculi[J]. Chinese Journal of Endourology(Electronic Edition), 2023, 17(06): 597-600.

目的

探讨经腹入路3D腹腔镜联合输尿管硬镜在肾盂输尿管连接部梗阻并肾盏结石手术中的安全性及有效性。

方法

回顾性分析2019年12月至2022年1月广东省第二人民医院收治并手术的14例肾盂输尿管连接部梗阻并肾盏结石的患者临床资料,分析肾盏结石大小、结石数量、手术时间、术中失血量及一期结石清除率及手术效果。

结果

所有患者均采用经腹3D腹腔镜下肾盂离断成形术,术中输尿管镜经腔镜通道进入肾盂肾盏找到结石,取出结石。结石大小(0.89±0.32) cm,结石数量2~6枚,手术时间(138±18)min,术中失血量(12±5)ml,一期结石清除率100%,术后6~8周拔除输尿管支架管,术后3个月复查CT示肾积液缓解或消失,无肾结石复发及肾积液加重。

结论

3D腹腔镜联合输尿管硬镜在肾盂输尿管连接部梗阻并肾盏结石治疗中安全有效,具有创伤小,清石率高,是部分肾盂输尿管连接部梗阻合并肾盏结石患者治疗的良好选择。

Objective

To investigate the safety and efficacy of 3D laparoscopy combined with ureteroscopy in the treatment of ureteropelvic junction obstruction complicated with calyx calculi.

Methods

The clinical data of 14 patients with renal pelvic ureteral junction obstruction and renal calyx stones who were admitted and operated in Guangdong Second Provincial General Hosptial from December 2019 to January 2022 were analyzed retrospectively. The size of kidney stones, number of stones, operation time, intraoperative blood loss, and one-stage stone removal rate and surgical effect were collected and analyzed.

Results

All patients underwent transabdominal 3D laparoscopic nephroplasty. The ureteroscope was placed in the renal pelvis and calyces through the laparoscopic channel to find and remove calyx stone. The mean stone size was (0.89±0.32) cm, the number of stones was 2-6, the operation time was (138±18) min, the intraoperative blood loss was (12±5) ml, the primary stone clearance rate was 100%, The ureteral stent was removed 6-8 weeks after operation, and CT scan revealed hydronephrosis significant reduced or disappeared 3 month after operation, and there was no recurrence of renal calculus or aggravation of hydronephrosis.

Conclusion

3D laparoscopy combined with rigid ureteroscopy is safe, effective, minimal invasive and has a high stone removal rate in the treatment of renal pelvic ureteral junction obstruction with calyx calculus, which is a good alternative therapy for partial UPJO with calyx calculi patients.

图1 3D腹腔镜联合输尿管硬镜同期处理UPJO和肾盏结石注:a为腔镜下剪开肾盂,不离断;b、c为腹腔镜下辅助输尿管硬镜进入肾盏碎石取石;d为腹腔镜吸引器吸出输尿管镜冲洗液;e、f为输尿管硬镜下异物钳取出结石;g为碎小结石用腔镜吸引器吸出;h、i、j、k为裁剪肾盂输尿管,置管,UPJ吻合
[1]
Autorino R, Eden C, El-Ghoneimi A,et al. Robot-assisted and laparoscopic repair of ureteropelvic junction obstruction: a systematic review and meta-analysis[J]. Eur Urol, 2014, 65(2): 430-452.
[2]
Mittal S, Aghababian A, Eftekharzadeh S, et al. Robot-Assisted laparoscopic ureterocalicostomy in the setting of ureteropelvic junction obstruction: a multi-institutional cohort[J]. J Urol, 2022, 208(1): 180-185.
[3]
Skolarikos A, Dellis A, Knoll T. Ureteropelvic obstruction and renal stones: etiology and treatment[J]. Urolithiasis, 2015, 43(1): 5-12.
[4]
谢汉平,徐耀鹏,文瀚东,等.机器人联合膀胱软镜治疗肾盂输尿管连接处狭窄合并继发性肾结石一例报告及文献复习[J/OL].中华腹腔镜泌尿外科杂志(电子版), 2020, 14(1): 61-63.
[5]
Hüttenbrink C, Kelm P, Klein T, et al. Combination of robotic pyeloplasty and percutaneous renal surgery for simultaneous treatment of ureteropelvic junction obstruction and calyx stones[J]. Urol Int, 2021,105(7-8): 637-641.
[6]
Yang C, Zhou J, Lu ZX, et al. Simultaneous treatment of ureteropelvic junction obstruction complicated by renal calculi with robotic laparoscopic surgery and flexible cystoscope[J]. World J Urol, 2019, 37(10): 2217-2223.
[7]
An L, Xiong L, Chen L, et al. Concomitant treatment of ureteropelvic junction obstruction complicated by renal calculi with laparoscopic pyeloplasty and pyelolithotomy via 19.5f rigid nephroscope: a report of 12 cases[J]. J Invest Surg, 2022, 35(1): 77-82.
[8]
Wei C, Wang T, Chen S,et al. Concomitant management of renal calculi and recurrent ureteropelvic junction obstruction with percutaneous nephrolithotomy and antegrade balloon dilation[J]. J Int Med Res, 2020, 48(5): 300060520911252.
[9]
Wang X, Li S, Liu T, et al. Laparoscopic pyelolithotomy compared to percutaneous nephrolithotomy as surgical management for large renal pelvic calculi: a meta-analysis[J]. J Urol, 2013,190(3):888-893.
[10]
Malkhasyan VA, Semenyakin IV, Ivanov VY, et al. Complications of percutaneous nephrolithotomy and their management[J]. Urologiia, 2018, (4): 147-153.
[11]
Rasool S, Singh M, Jain S, et al. Comparison of open, laparoscopic and robot-assisted pyeloplasty for pelviureteric junction obstruction in adult patients[J]. J Robot Surg, 2020, 14(2): 325-329.
[12]
Esposito C, Masieri L, Castagnetti M, et al. Robot-assisted vs laparoscopic pyeloplasty in children with uretero-pelvic junction obstruction (UPJO): technical considerations and results[J]. J Pediatr Urol, 2019 15(6): 667.e1-667.e8.
[13]
Mantica G, Ambrosini F, Parodi S, et al. Comparison of safety, efficacy and outcomes of robot assisted laparoscopic pyeloplasty vs conventional laparoscopy[J]. Res Rep Urol, 2020, 12: 555-562.
[14]
Scarcella S, Tiroli M, Torino G, et al. Combined treatment of ureteropelvic junction obstruction and renal calculi with robot-assisted laparoscopic pyeloplasty and laser lithotripsy in children: case report and non-systematic review of the literature[J]. Int J Med Robot, 2021, 17(3): e2246.
[15]
汪帮琦,赵永斌,张长征,等. 3D腹腔镜在肾脏肿瘤保留肾单位手术中的应用优势[J].中国内镜杂志, 2015, 21(11): 1126-1129.
[16]
Adanur S, Demirdogen SO, Altay MS, et al. Comparing the effects of 2d and 3d imaging systems on laparoscopic pyeloplasty outcomes in the treatment of adult ureteropelvic junction obstruction[J]. J Laparoendosc Adv Surg Tech A, 2022, 32(10): 1043-1047.
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