儿童肾盂输尿管连接部梗阻所致肾积水的腹腔镜治疗疗效分析
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摘要
目的:探讨腹腔镜经腹路径肾盂成形术治疗儿童肾盂输尿管连接部梗阻(UPJO)的临床疗效。方法:2016年1月～2018年1月我院采用腹腔镜经腹路径肾盂成形术治疗UPJO肾积水患儿50例,其中男44例,女6例;年龄6个月～14岁,平均(5.73±0.84)岁。术后定期随访,分别于2周及1、3、6、12个月门诊复查临床疗效及B超检查,测量肾盂前后径扩张程度及肾实质厚度。结果:50例患儿UPJO诊断明确,均采用腹腔镜经腹路径肾盂成形术,手术均顺利成功,无中转开放手术。手术时间70～90min,平均(100.70±5.45)min;术中出血5～20ml,平均(10.00±3.32)ml。术后1周出院,患儿症状消失,体表无明显可见瘢痕。所有患儿均获得随访,B超提示术后2周患儿肾盂前后径扩张程度及肾实质厚度较术前出现好转,术后1个月均开始明显好转,与术前比较差异有统计学意义(P<0.05)。结论:腹腔镜经腹路径肾盂成形术治疗UPJO肾积水具有创伤小、恢复快、安全有效、美容效果好等优点,手术效果显著,有很好的应用前景。
Objective:To study the application of transperitoneal laparoscopic dismembered pyeloplasty in children with ureteropelvic junction obstruction(UPJO).Method:From Jan.2016 to Jan.2018,50 cases with UPJO underwent transperitoneal laparoscopic dismembered pyeloplasty.Among them male were 44 cases,female 6 cases.Their age was from 6 months to 14 years(mean,5.73±0.84)years old.The clinical efficacy and B-ultrasound(the anterior and the posterior diameter of pelvis,thickness of renal cortex)were reviewed 2 weeks,1 month,3 months,6 months and 12 months regularly after operation.Result:All operations were performed successfully without any complications,and no cases were converted to open surgery.The operation time was 70-90(mean,100.70±5.45)min,and the estimated intraoperative blood loss was 5-20(mean,10.00±3.32)ml.All patients discharged one week after operation without visible scar on the body surface.All cases had been followed up,and B-ultrasound examinations after the procedure showed hydronephrosis was improved.The anterior and the posterior diameter of pelvis and the thickness of renal cortes were improved two weeks after operation.And the data were significantly improved one month after operation.The difference was statistical(P<0.05).Conclusion:Transperitoneal laparoscopic dismembered pyeloplasty is a minimally invasive,effective,safe and good cosmetic method in the treatment of UPJO.It may be well used in the future.
Objective:To study the application of transperitoneal laparoscopic dismembered pyeloplasty in children with ureteropelvic junction obstruction(UPJO).Method:From Jan.2016 to Jan.2018,50 cases with UPJO underwent transperitoneal laparoscopic dismembered pyeloplasty.Among them male were 44 cases,female 6 cases.Their age was from 6 months to 14 years(mean,5.73±0.84)years old.The clinical efficacy and B-ultrasound(the anterior and the posterior diameter of pelvis,thickness of renal cortex)were reviewed 2 weeks,1 month,3 months,6 months and 12 months regularly after operation.Result:All operations were performed successfully without any complications,and no cases were converted to open surgery.The operation time was 70-90(mean,100.70±5.45)min,and the estimated intraoperative blood loss was 5-20(mean,10.00±3.32)ml.All patients discharged one week after operation without visible scar on the body surface.All cases had been followed up,and B-ultrasound examinations after the procedure showed hydronephrosis was improved.The anterior and the posterior diameter of pelvis and the thickness of renal cortes were improved two weeks after operation.And the data were significantly improved one month after operation.The difference was statistical(P<0.05).Conclusion:Transperitoneal laparoscopic dismembered pyeloplasty is a minimally invasive,effective,safe and good cosmetic method in the treatment of UPJO.It may be well used in the future.
引文
1 Nguyen H T,Benson C B,BromLey B,et al.Multidisciplinary consensus on the classification of prenatal and postnatal urinarytract dilation(UTD classification system)[J].J Pediatr Urol,2014,10(6):982-998.
2杨屹,刘鑫.产前肾积水的生后评价[J].临床小儿外科杂志,2018,16(6):405-407.
3 Liu D,Zhou H,Ma L,et al.Comparison of Laparoscopic Approaches for Dismembered Pyeloplasty in Children With Ureteropelvic Junction Obstruction:Critical Analysis of 11-Year Experiences in a Single Surgeon[J].U-rology,2017,101:50-55.
4 Abdel-Karim A M,Fahmy A,Moussa A,et al.Laparoscopic pyeloplasty versus open pyeloplasty for recurrent ureteropelvic junction obstruction in children[J].J Pediatr Urol,2016,12(6):401.e1-401.e6.
5张潍平,杨洋,汪添益.关于肾盂输尿管连接部梗阻病因和治疗的认识与争议[J].临床小儿外科杂志,2018,17(6):401-404.
6 Schuessler W W,Grune M T,Tecuanhuey L V,et al.Laparoscopic dismembered pyeloplasty[J].J Urol,1993,150(6):1795-1799.
7 Zhang X,Li H Z,Ma X,et al.Retrospective comparison of retroperitoneal laparoscopic versus open dismembered pyeloplasty for ureteropelvic junction obstruction[J].J Urol,2006,176(3):1077-1080.
8 Erol I·,Karamk K,I·slamoˇglu M E,et al.Outcomes of infants undergoing laparoscopic pyeloplasty:A singlecenter experience[J].Urologia,2018,25:1-5.
9周辉霞,熊祥华.儿童肾盂输尿管连接处梗阻手术方法的分析与评价[J].现代泌尿外科杂志,2015,20(10):685-688.
10 Baek M,Silay M S,Au J K,et al.Does the use of 5mm instruments affect the outcomes of robot-assisted laparoscopic pyeloplastyin smaller working spaces?Acomparative analysis of infants and older children[J].JPediatr Urol,2018,14(6):537.e1-537.e6.
11 Neheman A,Kord E,Zisman A,et al.Comparison of Robotic Pyeloplasty and Standard Laparoscopic Pyeloplasty in Infants:A Bi-Institutional Study[J].J Laparoendosc Adv Surg Tech A,2018,28(4):467-470.
12曹华林,周辉霞,罗小龙,等.非钳夹式吻合口缝合法在腹腔镜离断式肾盂成形术中的应用[J].中华小儿外科杂志,2016,37(2):139-143.
13 Peters C A,Schlussel R N,Retik A B.Pediatric laparoscopic dismembered pyeloplasty[J].J Urol,1995,153(6):1962-1965.
14陆鹏,何大维,林涛,等.单中心小儿泌尿系腹腔镜手术的并发症分析及防治[J].临床泌尿外科杂志,2017,32(2):88-96.
15韩晓敏,陈敏,肖亚军,等.腹腔镜离断式肾盂输尿管成形术治疗UPJO肾积水230例经验总结[J].临床泌尿外科杂志,2019,34(5):353-357.
2杨屹,刘鑫.产前肾积水的生后评价[J].临床小儿外科杂志,2018,16(6):405-407.
3 Liu D,Zhou H,Ma L,et al.Comparison of Laparoscopic Approaches for Dismembered Pyeloplasty in Children With Ureteropelvic Junction Obstruction:Critical Analysis of 11-Year Experiences in a Single Surgeon[J].U-rology,2017,101:50-55.
4 Abdel-Karim A M,Fahmy A,Moussa A,et al.Laparoscopic pyeloplasty versus open pyeloplasty for recurrent ureteropelvic junction obstruction in children[J].J Pediatr Urol,2016,12(6):401.e1-401.e6.
5张潍平,杨洋,汪添益.关于肾盂输尿管连接部梗阻病因和治疗的认识与争议[J].临床小儿外科杂志,2018,17(6):401-404.
6 Schuessler W W,Grune M T,Tecuanhuey L V,et al.Laparoscopic dismembered pyeloplasty[J].J Urol,1993,150(6):1795-1799.
7 Zhang X,Li H Z,Ma X,et al.Retrospective comparison of retroperitoneal laparoscopic versus open dismembered pyeloplasty for ureteropelvic junction obstruction[J].J Urol,2006,176(3):1077-1080.
8 Erol I·,Karamk K,I·slamoˇglu M E,et al.Outcomes of infants undergoing laparoscopic pyeloplasty:A singlecenter experience[J].Urologia,2018,25:1-5.
9周辉霞,熊祥华.儿童肾盂输尿管连接处梗阻手术方法的分析与评价[J].现代泌尿外科杂志,2015,20(10):685-688.
10 Baek M,Silay M S,Au J K,et al.Does the use of 5mm instruments affect the outcomes of robot-assisted laparoscopic pyeloplastyin smaller working spaces?Acomparative analysis of infants and older children[J].JPediatr Urol,2018,14(6):537.e1-537.e6.
11 Neheman A,Kord E,Zisman A,et al.Comparison of Robotic Pyeloplasty and Standard Laparoscopic Pyeloplasty in Infants:A Bi-Institutional Study[J].J Laparoendosc Adv Surg Tech A,2018,28(4):467-470.
12曹华林,周辉霞,罗小龙,等.非钳夹式吻合口缝合法在腹腔镜离断式肾盂成形术中的应用[J].中华小儿外科杂志,2016,37(2):139-143.
13 Peters C A,Schlussel R N,Retik A B.Pediatric laparoscopic dismembered pyeloplasty[J].J Urol,1995,153(6):1962-1965.
14陆鹏,何大维,林涛,等.单中心小儿泌尿系腹腔镜手术的并发症分析及防治[J].临床泌尿外科杂志,2017,32(2):88-96.
15韩晓敏,陈敏,肖亚军,等.腹腔镜离断式肾盂输尿管成形术治疗UPJO肾积水230例经验总结[J].临床泌尿外科杂志,2019,34(5):353-357.