无支架腹腔镜下肾盂输尿管成形术治疗儿童肾盂输尿管连接部梗阻

Stentless laparascopic pyeloplasty in children with ureteropelvic junction obstruction

摘要:

目的：探索无支架腹腔镜下肾盂输尿管成形术在治疗儿童肾盂输尿管连接部梗阻（ureteropelvic junction obstruction，UPJO）中的应用。方法：收集45例我院2015年7月至2016年6月因UPJO行无支架腹腔镜下肾盂输尿管成形术的患儿临床资料（无支架组）。以患儿的年龄、积水程度、术前有无临床症状为指标，用逐一配对方法选取45例本院前期或同期行腹腔镜下肾盂输尿管成形术置入双J管引流的病例（双J管组）为对照，比较2组手术时间、术后住院时间、术后并发症发生率及远期随访情况。结果：2组手术均顺利完成，无中转开放。无支架组术后平均住院时间低于双J管组[（8.64±3.18） d vs. （9.05±1.28） d，t=-0.789，P=0.434]，无支架组平均手术时间低于双J管组[（98.39±18.02） min vs. （106.93±25.77） min，t=-1.81，P=0.077]，均无统计学差异；无支架组术后尿路感染发生率（3/45）低于双J管组（4/45），差异无统计学意义（?字2=0.155，P=0.500）；无支架组术后血尿发生率（5/45）高于双J管组（4/45），差异无统计学意义（?字2=0.123，P=0.500）；无支架组术后尿外渗发生率（13/45）高于双J管组（1/45），差异有统计学意（?字2=12.18，P=0.000）。远期随访患儿均无临床症状、肾盂积水有不同程度缓解。结论：无支架腹腔镜下肾盂输尿管成形术治疗儿童肾盂输尿管连接部梗阻是可行的。

Abstract:

Objective：To explore the application of stentless laparascopic pyeloplasty in children with ureteropelvic junction obstruc－tion（UPJO）. Methods：Clinical data of 45 UPJO children underwent stentless laparascopic pyeloplasty from July 2015 to June 2016 were collected and matched with D-J tube drainage. The relevant clinical data were analyzed. Results：All operations were completed successfully without converting to open surgery. The postoperative hospital stay was shorter in stentless group than in D-J group [（8.64±3.18） d vs. （9.05±1.28） d，t=-0.789，P=0.434]；the mean operation time was shorter in stentless group than in D-J group [（98.39±18.02） min vs. （106.93±25.77） min，t=-1.81，P=0.077]，and no significant differences was observed. The postoperative uri－nary tract infection rate was lower in stentless group（3/45） than in D-J group（4/45） without significant differences（?字2=0.155，P=0.500）. Postoperative hematuria rate was higher in stentless group（5/45） than in D-J group（4/45） without significant differences （?字2=0.123，P=0.500）. The postoperative urinary extravasation rate was higher in stentless goup（13/45） than in D-J group（1/45） with significant differences（?字2=12.18，P=0.000）. Long-time follow-up showed all children were asymptomatic and hydronephrosis was relieved in varying degrees. Conclusion：Stentless laparas－copic pyeloplasty is feasible in the treatment of UPJO in chil－dren.