比较离断性肾盂成形术不同手术方式治疗小儿肾盂输尿管连接部狭窄所致肾积水的效果分析

Comparison of clinical efficacy of dismembered pyeloplasty via different surgical approaches in the treatment of UPJO induced hydronephrosis in children

摘要:

目的 比较离断性肾盂成形术不同手术方式治疗小儿先天性肾盂输尿管连接部狭窄（ureteropelvic junction obstruction，UPJO）所致肾积水的效果。方法 回顾性选取安徽省儿童医院2019年1月至2021年10月收治的90例小儿UPJO所致肾积水患儿临床资料，根据手术方式分为腹腔镜组（n=49）和常规组（n=41），腹腔镜患儿采用三孔腹腔镜离断式肾盂成形术治疗，常规组患儿采用腰腹部横切口离断式肾盂成形术治疗。对比2组患儿术中吻合时间、术中出血量、手术切口长度以及术后对乙酰氨基酚用量；对比2组患儿手术前后肾盂前后径和肾皮质厚度；对比2组患者术后平均住院时间、术后平均进食时间以及术后住院费用；对比2组患儿术后切口感染、尿外渗、发热等并发症发生率。结果 与常规组患儿相比，腹腔镜组患儿术中吻合时间和手术切口长度更短，术中出血量和术后对乙酰氨基酚用量更低（P<0.05）；手术后，相比于常规组，腹腔镜组患儿肾盂前后径更低，肾皮质厚度更高（P<0.05）；与常规组患儿相比，腹腔镜组患儿术后平均住院时间更短，术后平均进食时间更短，术后住院费用更低（P<0.05）；腹腔镜组患儿并发症发生率为12.24%（6/49），低于常规组患儿的36.58%（15/41）（P<0.05）。结论 小儿UPJO所致肾积水离断性肾盂成形术运用三孔腹腔镜手术的效果显著高于传统腰腹部横切口手术。

Abstract:

Objective To compare the clinical efficacy of dismembered pyeloplasty via different surgical approaches in the treatment of ureteropelvic junction obstruction（UPJO） induced hydronephrosis in children.Methods The clinical data of 90 children with hydronephrosis caused by UPJO admitted to Anhui Children’s Hospital from January 2019 to October 2021 were retrospectively selected. According to the approach of the dismembered pyeloplasty，they were divided into laparoscopic group（n=49） and conventional group（n=41）. The laparoscopic children were treated with three-hole laparoscopic dismembered pyeloplasty， and the conventional group were treated with the dismembered pyeloplasty through the transverse incision of the waist and abdomen. The anastomotic time，the amount of bleeding，the length of incision and the amount of paracetamol after operation were compared between the two groups. Comparison of anterior and posterior renal pelvis diameter and renal cortical thickness before and after surgery in the two groups was also made. The average hospitalization time， average feeding time and hospitalization expenses after operation were compared between the two groups. The incidence of complications such as incision infection，urinary exostosis and fever were compared between the two groups.Results Children in the laparoscopic group had shorter intraoperative anastomosis time and incision lengths，and lower intraoperative bleeding and postoperative acetaminophen doses than children in the conventional group（P<0.05）. After surgery， children in the laparoscopic group had lower anterior and posterior pelvic diameters and higher renal cortical thickness compared to the conventional group（P<0.05）. Children in the laparoscopic group had a shorter average postoperative hospital stay，a shorter average postoperative feeding time and lower postoperative hospital costs than children in the conventional group（P<0.05）. The complication incidence of children in the laparoscopic group was 12.24%（6/49） lower than that of children in the conventional group，which was 36.58%（15/41）（P<0.05）.Conclusion The results of dissecting pyeloplasty for hydronephrosis due to UPJO in the pediatric population are significantly better with a three-hole laparoscopic procedure than with a conventional transverse lumbar abdominal incision.