双线悬吊法经腹腔入路腹腔镜下肾盂成形术

目的探讨双线悬吊法经腹腔入路腹腔镜下肾盂成形术的临床价值。 方法2016年9月至2018年11月在连云港市第一人民医院采取双线悬吊法经腹腔入路腹腔镜下肾盂成形术患者22例，其中男19例，女3例。年龄4个月～14岁，平均年龄（5.3±2.7）岁。左侧20例，右侧1例，双侧1例，共23侧。右侧经结肠肝曲系膜缘打开侧腹膜入路，左侧经结肠系膜入路，在术中将输尿管和肾盂切口的两端用双线悬吊于腹壁，以便于缝合，用5-0可吸收线行Anderson-Hynes肾盂输尿管成形术，并从吻合口留置双J管，术后结合超声检查随访。 结果22例顺利完成手术，无中转开腹手术者。手术时间90～260 min，单侧平均（137±55）min。术中失血5～20 ml。平均住院时间7 d。术后1例因返流反复发热，在拔出双J管后症状消失，1例发生尿外渗，保留腹腔引流3 d后自愈。术后随访6～25个月，患儿临床症状消失，复查超声提示肾积水消失或减少，肾皮质逐渐增厚。 结论双线悬吊法经腹腹腔镜下肾盂成形术是一种安全、有效、容易学习的手术方法。

Transperitoneal laparoscopic pyeloplasty with double-line suspension

ObjectiveTo explore the clinical value of transperitoneal laparoscopic pyeloplasty with double-line suspension. MethodsTwenty-two pediatric patients with ureteropelvic junction obstruction (UPJO) underwent transperitoneal laparoscopic pyeloplasty with double-line suspension from September 2016 to November 2018 in the First People’s Hospital of Lianyungang. Among them, 19 males and 3 females aged from 4 months to 14 years with average of (5.3±2.7) years. Twenty patients had obstruction on the left ureteropelvic junction and one on the right, and one bilateral, twenty-three laterals in total. The right side UPJO were exposured via open the side peritoneum of colon. The left side UPJO were exposured via open mesentery. During the operation, two line were sutured to the ends of the ureter and renal pelvis hunging to the abdominal wall to make anastomotic suturing more easily. The renal pelvis and ureter were anastomosed using 5-0 absorbable sutures anda double-J ureteric stent was placed through the anastomotic stoma. Patients were followed-up by ultrasound. ResultsAll operations were successful. None was converted to open surgery. The operative time was 90-260 min, The mean operative time was (137±55) min. The blood loss was 5-20 ml. The median duration of hospitalization was 7 days. One case had a fever due to reflux, the symptom disappeared after removal of the double J stent one month later. One case appeared urinary ofextravasation, which naturally disappeared after three days drainage. With 6 to 25 months of follow-up, the clinical symptomsdisappeared and the hydronephrosis gradually improved. ConclusionTransperitoneal laparoscopic pyeloplasty with double-line suspension is not only safe and effective but also a easy-to-learn surgical method.