儿童肾盂成形术后严重尿外渗的临床特点及预后分析  

Massive urinary extravasation after pyeloplasty in children:clinical features and prognoses

作　　者：汪添益 张宇 付明翠[1] 张婷[1] 曹戌[1] 夏红亮[1] 戴澍[1] 成毅 严向明[1] 周云[1] Wang Tianyi;Zhang Yu;Fu Mingcui;Zhang Ting;Cao Xu;Xia Hongliang;Dai Shu;Cheng Yi;Yan Xiangming;Zhou Yun(Department of Urology,Children's Hospital,Soochow University,Suzhou 215002,China;Department of Pediatric Surgery,Qinghai Women&Children's Hospital,Xining 810007,China)

机构地区：[1]苏州大学附属儿童医院泌尿外科,苏州215002 [2]青海省妇女儿童医院小儿外科,西宁810007

出　　处：《临床小儿外科杂志》2024年第4期323-327,共5页Journal of Clinical Pediatric Surgery

基　　金：江苏省高等学校自然科学研究项目(23KJD320003);苏州市科技发展计划项目(SKY2023002);苏州市儿童结构畸形重点实验室建设项目(SZS2022018);青海省卫生健康委员会科研项目(2023—wjzdx—44);苏州市科技发展计划(医疗卫生科技创新)项目(SKY2022053)

摘　　要：目的探讨儿童肾盂成形术后严重尿外渗的临床特点与预后情况。方法回顾性分析2016年1月至2023年12月苏州大学附属儿童医院泌尿外科行肾盂成形术后出现严重尿外渗的18例肾盂输尿管连接处梗阻患儿临床资料。记录患儿人口学资料、既往病史、术前与术后影像学检查结果、住院期间尿外渗信息、治疗结局以及预后情况。结果18例中,男16例、女2例;手术年龄(6.03±4.79)岁;梗阻位于左侧16例、右侧2例;住院时间20(13,24)d。术后严重尿外渗持续时间中位数为2 d,范围1~20 d。17例术后留置腹腔引流管,留置时间为11(8,15)d,单日腹腔引流液体量最大值为485(298,786)mL。术后并发症Clavien分级:Ⅰ级8例、Ⅱ级4例、Ⅲb级6例,住院期间二次手术发生率为33.33%(6/18)。术前、术后肾盂前后径(anteroposterior diameter of renal pelvis,APD)分别为(4.11±1.83)cm和2.40(1.58,4.53)cm,差异有统计学意义(Z=-2.628,P=0.009)。术前、术后肾实质厚度最小值(parenchyma thickness minimum,PT_(min))分别为0.6(0.2,0.8)cm和(0.93±0.32)cm,差异有统计学意义(Z=-2.580,P=0.011)。术前、术后APD/PT值分别为6.05(2.85,13.44)和2.64(1.95,5.73),差异有统计学意义(Z=-2.940,P=0.002)。肾盂前后径改善百分比(APD improvement rate,PI-APD)为20.95%(-0.45%,60.91%)。中位随访时间24个月。术后出现再梗阻2例,手术成功率为88.89%(16/18)。结论肾盂成形术后严重尿外渗可导致住院期间二次手术风险增加,但患儿远期肾积水情况较术前明显缓解,再梗阻的发生率较低。Objective To explore the clinical features and outcomes of massive urinary extravasation after pyeloplasty in children.Methods From January 2016 to December 2023,the relevant clinical data were retrospectively reviewed for 18 children with massive urinary extravasation after pyeloplasty.Demographic profiles,medical history,perioperative images,urinary extravasation during hospitalization,and treatment outcomes were recorded.Results There were 16 boys and 2 girls with an operative age of(6.03±4.79)year.Obstruction was located at left(n=16)and right(n=2).Length of hospitalization stay was 20(13-24)day and median duration of massive postoperative urinary extravasation 2(1-20)day.In 17/18 children,abdominal drainage tube was retained for a median duration of 11(8-15)day.The highest volume of abdominal drainage fluid withinin a single day was 485(298-786)ml.Clavien-Dindo grade of postoperative complications wasⅠ(n=8),Ⅱ(n=4)andⅢb(n=6).The frequency of reoperation during hospitalization was 33.33%(6/18).The perioperative APD were(4.11±1.83)and 2.40(1.58,4.53)cm with statistically significant difference(Z=-2.628,P=0.009).Perioperative PTmin was 0.6(0.2,0.8)and(0.93±0.32)cm with statistically significant difference(Z=-2.580,P=0.011).Perioperative ratio of APD/PT was 6.05(2.85-13.44)and 2.64(1.95-5.73)with statistically significant difference(Z=-2.940,P=0.002).Postoperative values of APD,PT_(min),and APD/PT significantly improved as compared preoperatively.PI-APD was 20.95%(-0.45%,60.91%).There were two cases of postoperative re-obstruction.Overall success rate of operation was 88.89%(16/18).Conclusions Severe urinary extravasation after pyeloplasty may result in an extended duration of hospitalization and an elevated probability of reoperation.However,the occurrence of re-obstruction after pyeloplasty with massive urine extravasation remains low.

关 键 词：肾盂输尿管连接处梗阻 腹腔镜检查 肾盂成形术 手术后并发症 尿外渗 儿童 

分 类 号：R726.9[医药卫生—儿科]