Transperitoneal Laparoscpic Dismembered Pyeloplasty For Ureteropelvic Junction Obstruction In Children

Objective：Children with hydronephrosis is a common and multiple disease in clinic, whichbelongs to the congenital dysplasia or malformation. Due to the limitation of theeconomic level of our country, most areas especially in remote areas are still in poormedical conditions. At present, the prenatal diagnosis and care of infants have not yetgained popularity. Because of most children with hydronephrosis without symptoms,which result in a lot of hydronephrosis in children is difficult to be early, timely,efficient diagnosis and treatment. Physiological hydronephrosis in follow-up review,can disappear. The pathological mild hydronephrosis, prompt release of obstruction,renal morphology still can be restored, features can be partially or completelyrestored to normal. However, as in severe hydronephrosis, when renal tissue atrophyor fibrosis, which will difficult to repair. Kidney will eventually progressiveevolution into non functional big water bag. In general, hydronephrosis in children isthe main reason of congenital ureteropelvic junction obstruction (UPJO) caused by.Operation treatment for children with hydronephrosis, classic open operation-Anderson-Hynes is the gold standard for the treatment of UPJO, studies haveshown that the operation success rate can reach90%or more. Influenced by thetraditional concept of the doctor in the Department of Urology, that is still regarded asoperation in the treatment of children with UPJO But open dismembered pyeloplastyhas many disadvantages, such as larger wounds, pain after the operation,postoperative need longer time to return to normal life. These factors can influencechildren’s physical and mental development. Laparoscopic operation developmentsince the last century90’s, has been gradually applied to the adrenal, kidney and urologic operation. Because of its advantages such as small operation wound.In thefield of pediatric department of Urology, have been used for a variety of commondiseases of urinary system operation. In this paper the laparoscopic pyeloplasty forureteropelvic junction obstruction (transperitoneal) treatment of hydronephrosiscaused by UPJO in children, because of its clinical application in a relatively shorttime, relevant research literatures and data is still relatively few, the operation safety,operation effect needs further observation. For the children, because they are in thelife development critical period, how to timely treatment, choose appropriate time andappropriate treatment is particularly important for them. Through the investigation of45cases of transperitoneal laparoscopic dismembered pyeloplasty for the treatment ofhydronephrosis caused by UPJO in children in the follow-up study, analysis oflaparoscopic pyeloplasty disconnection type clinical effect in the treatment ofhydronephrosis in children patients, to provide more support for the promotion oflaparoscopic treatment of hydronephrosis in children.Methods：All45ases from our hospital department of Urology from May2008toDecember2013diagnosised of hydronephrosis.20patients in laparoscopy group(experimental group), the25cases in open operation group (control group).All caseschosed operation mode free by the guardians. And the actual measurement ofbleeding in the operation, there were no complications and postoperative follow-upultrasound, MRU, urinary CT,99mTc, DTPA renal dynamic imaging and GFRmeasurement inspection, measuring the degree of hydronephrosis, renal function. Theindices and data recovery normal study after operation. Investigation on the follow-upafter treatment in children with early time after operation, postoperative follow-upfrom children with pyeloplasty ended after removal of ureteral stent after untilfollow-up found that treatment failure, follow-up time nodes were removed ureteralstent after3months,6months,12months,1years. By reviewing medical records,follow-up other means to obtain postoperative related data, and the recent clinicaleffect comparison of two operation modes. Results：The operation of45cases were successfully completed, no operation relatedcomplications and side injury during operation, no blood transfusion. Thelaparoscopic group without conversion to open. The average amount of bleedingduring operation, postoperative hospitalization days differences were statisticallysignificant (P <0.05), Complications after operation and operation effect comparedwith each other have no significant difference (P>0.05).Discussion:Pyeloplasty in the removal of obstruction of ureter, renal pelvis, funnelform toreshape, excretion mechanism makes the ureteropelvic junction back to normal shape,to obtain good urine excretion function, is an effective method in the treatment ofUPJO. Laparoscopic pyeloplasty can effectively improve the clinical symptoms ofpatients with hydronephrosis and obtained satisfactory curative effect compared withopen pyeloplasty.But also with less pain, shorter recovery time. Transperitoneallaparoscopic pyeloplasty vision, easy suture, large small trauma, faster postoperativerecovery, is the ideal method of operation in treatment of children with UPJO.