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Laparoscopic Pyeloplasty in Secondary Ureteropelvic Junction Obstruction Due to Failed Open or Laparascopic Surgery

Author: WanLiJun
Tutor: ZhangDaHong
School: Zhejiang University
Course: Surgery
Keywords: Laparoscopic Pyeloplasty PUJ
CLC: R699.2
Type: Master's thesis
Year: 2008
Downloads: 19
Quote: 0
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Abstract


1, the background and purpose of PUJ resistance will lead to the expansion of the renal collecting system and affect kidney function, causing pain, infections and other clinical manifestations. Disarticulation of traditional open pyeloplasty can form the pelvis funnel, excision of lesions of the renal pelvis and ureter, high success rate, more than 90%, long-term effect has been achieved, the most widely accepted treatment PUJ obstruction of the gold standard. Incision length, trauma, slow recovery, many patients will be long-term incisional pain, the impact on the labor. In the past ten years, the rapid development of urology laparoscopic techniques. Since 1993 the Schuessler and his colleagues first reported laparoscopic pyeloplasty postoperative, the technology has become increasingly mature. A lot of literature, and its success rate and long-term results with open surgery, but the trauma, quicker recovery, small impact on the labor force, has been gradually replace open surgery, to become the new gold standard. Skilled with laparoscopic techniques, previously considered also began to explore the field of laparoscopic surgery contraindications. Because open surgery and laparoscopic surgery will cause severe scar adhesions, resulting in the same part of reoperation difficulties. The domestic no ability to re-open or laparoscopic pyeloplasty surgery obstruction underwent laparoscopic pyeloplasty bulk cases reported. In the past three years, based on a wealth of experience in laparoscopic surgery, and skilled endoscopic suture knot technology, we were again laparoscopic pyeloplasty. In this study, by comparing the first time, and again, the laparoscopic pyeloplasty clinical data, and compared with the relevant literature to explore the feasibility and efficacy of open or laparoscopic pyeloplasty failed again after laparoscopic pyeloplasty. Methods From September 2004 to May 2008, we pelvis of 11 patients with ureteropelvic junction obstruction line forming patients with recurrent obstruction (9 cases open surgery, laparoscopic surgery, 2 cases) via intraperitoneal approach line Laparoscopic pyeloplasty (A group). Establishing pneumoperitoneum after careful observation of the anatomical location and the degree of adhesion of the abdominal organs and open side peritoneum, from the kidney on the upper section of the pole or ureter relative adhesion sites, using ultrasonic scalpel sharp cutting and suction blunt dissection phase combination of methods, and gradually free the renal pelvis and upper ureter, fully exposed and excised narrow segment purposes isolated Continuity pelvis angioplasty, and placing double J tube. 15 cases over the same period to carry out the first time laparoscopic pyeloplasty (B group). The recorded preoperative analysis of two groups of patients, age, gender, weight, left and right side and stagnant water level. Were compared operative time, intraoperative and postoperative complications, length of hospital stay and surgery success rate. Operative time and blood loss reported in the literature and the results compared. The success rate of surgery to determine the remission of clinical symptoms and radiographic improvement of hydrocephalus and renal. The two sets of data through specialized statistical software SPSS 16.0, depending on select T-test analysis, X to 2 test, P lt; 0.05 for the difference was statistically significant. 3. Preoperative two groups of patients in age, sex, left and right side, and hydrocephalus extent no significant difference (P gt; 0.05). There were no serious intraoperative complications, no conversion to open surgery. As part of open surgery after two short surgical interval (lt; 12 weeks), severe adhesion around nephroureterectomy, separation bleed easily, so again the average operative time and blood loss in the surgical group than the initial surgery group (P lt; 0.05), but there was no difference in the time of the ureteropelvic anastomosis. Reoperation time with our previous report initial laparoscopic pyeloplasty surgery time no difference (P lt; 0.05), and significantly shorter the foreign literature again laparoscopic surgery time (P lt; 0.05), while the amount of bleeding is also open surgery literature reports no significant difference (P gt; 0.05). The patients postoperative hospital stay and surgery success rate was no significant difference (P gt; 0.05). 4 Conclusions The findings prompted: for the first time open surgery or laparoscopic surgery can cause adhesions around the ureteropelvic to give again laparoscopic pyeloplasty difficult, but as long as the laparoscopic operation skilled laparoscopic renal pelvis again angioplasty is feasible and safe, but also to maintain the benefits of minimally invasive laparoscopic surgery. Intraperitoneal channels easier to complete the surgery. Compared with the report on the results of foreign literature, shorter operative time, skilled relevant endoscopic separation and suture techniques.

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CLC: > Medicine, health > Surgery > Urology ( urinary and reproductive system diseases) > Urinary tract and male reproductive system surgery > Kidney surgery
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