The Clinical Significance Study Of Retroperitoneal Laparoscopic Dismembered Pyeloplasty For Uretero-Pelvic Junction Obstruction

Objective:Evaluating the clinical significance of retroperitoneal laparoscopic dismembering pyeloplasty compared with open surgery in the treatment of Uretero-Pelvic Junction (UPJ) obstruction,Then we can provide scientific proof for spreading the method of retroperitoneal laparoscopic dismembering pyeloplasty.Method:We performed 62 retroperitoneal laparoscopic dismemberd pyeloplasty (A group) from January 2002 to January 2009 and 78 open surgery (B group) from January 2001 to January 2009. The differences between the two groups were compared and statistically analyzed in regard to the patients' sex, the age, height, weight, the main diagnosis,the clinical manifestation, the imaging findings, the combined disease,the operative time, the estimated blood loss, the postoperative fasting time, the length of incision,postoperative activities, the time of analgesic use, the time of intravenous antibiotic, the wound drainage time, the time of analgesic use, the postoperative complications, the postoperative hospital stay. the total hospital charges, the situation of hydronephrosis, time of resume work.Result:Comparing the results of laparoscopic dismembered pyeloplasty with open operation,the age,the sex,the lesion side, the situation of preoperative hydronephrosis, the situation of preoperative renal function, the body mass index, the main complications, the improved rate of postoperative hydronephrosis, the recovery rate of renal function, the postoperative stenosis rate and the total hospital charges were no significant differences (P>0.05). In the operative time,the open approach was less than laparoscopic approach(P<0.05). but the estimated blood loss, the length of incision,the time of analgesic use,the postoperative fasting time,the postoperative activities,the time of intravenous antibiotic, the postoperative hospital stay, the wound drainage time, the minor complications and the time of resume work were statistically significant different (P<0.05),the laparoscopic approach was more minimally invasive than the open approach. the internal drainage group was less than external drainage group in complications (P<0.05)Conclusion:1.Retroperitoneal laparoscopic dismembering pyeloplasty is an effective and minimally invasive approach, including less discomfort, shorter hospital stay, lower complication rate, and shorter time to convalescence. It has potential to replace open dismembered surgery as the standard for treatment of Ureteropelvic Junction Obstruction.2.Retroperitoneal laparoscopic dismembering pyeloplasty has the longer operative,duration steep learning curve requires. With the steady increase in expertise technical laparoscopic experience and education,the operation time can be close to the open pyeloplasty.3. Laparoscopic dismembering pyeloplasty still can achieve satisfactory effects in children(<5 years).4.It can have the satisfaction surgical space and reduce the occurrence of hypercapnia, if we select 8mmHg pneumoperitoneum press in children(<5 years).5.Double-J tube placement has satisfactory clinical efficacy, also can simplify surgical procedures and facilitate postoperative management.