腹腔镜及开放手术治疗儿童先天性肾盂输尿管连接处梗阻性肾积水的并发症对比  

Comparative analysis of complications between open and laparoscopic pyeloplasty for congenital ureteropelvic junction obstructive hydronephrosis in children

作　　者：何雨竹 李佳义 宋宏程[1] 张潍平[1] 孙宁[1] 田军[1] 李明磊[1] 李宁[1] 屈彦超[1] 韩文文[1] 杨洋[1] 李振武[1] 梁海燕[1] 刘超[1] 林德富[1] 王冠男[1] He Yuzhu;Li Jiayi;Song Hongcheng;Zhang Weiping;Sun Ning;Tian Jun;Li Minglei;Li Ning;Qu Yanchao;Han Wenwen;Yang Yang;Li Zhenwu;Liang Haiyan;Liu Chao;Lin Defu;Wang Guannan(Department of Urology,Beijing Children's Hospital,Capital Medical University,National Center for Children's Health,Beijing 100045,China)

机构地区：[1]国家儿童医学中心,首都医科大学附属北京儿童医院泌尿外科,北京100045

出　　处：《临床小儿外科杂志》2024年第4期315-322,共8页Journal of Clinical Pediatric Surgery

基　　金：北京市科委、中关村管委会"医药创新品种及平台培育"专项资助(Z231100004823034)

摘　　要：目的比较腹腔镜及开放离断式肾盂成形术治疗儿童先天性肾盂输尿管连接处梗阻(ureteropelvic junction obstruction,UPJO)性肾积水的术中及术后并发症特点,探讨导致两种手术方式并发症差异的影响因素。方法回顾性分析2016年7月至2018年12月首次于首都医科大学附属北京儿童医院接受腹腔镜或开放离断式肾盂成形术治疗的美国胎儿泌尿外科协会(Society for Fetal Urology,SFU)分级为Ⅳ级的UPJO肾积水患儿临床资料,共560例患儿583例肾。按照手术方式分为腹腔镜组(355例肾)和开放组(228例肾),对比分析两组并发症发生率、发生次数以及并发症等级和类型。比较不同引流方式、有无术中并发症以及不同年龄、体重、术前肾盂前后径(anteroposterior pelvic diameter,APD)及术者经验分层因素下的并发症差异。结果开放组患儿年龄16.37(9.73,61.37)个月,体重11.00(9.32,20.00)kg,明显小于腹腔镜组[年龄46.87(19.08,90.49)个月,体重16.50(12.00,25.00)kg]。开放组术前中位肾盂前后径为39.00(27.00,52.00)mm,长于腹腔镜组的28.00(22.00,36.00)mm,差异有统计学意义(P<0.05)。腹腔镜组和开放组术中并发症发生率(分别为7.61%和4.39%)、术后并发症发生率(分别为17.15%和15.56%)、术后并发症发生次数占总发生次数比例(分别为23.84%和20.88%)以及吻合口再狭窄发生率(分别为2.62%和1.33%)比较,差异均无统计学意义(P>0.05)。两组最常见的术后并发症均为泌尿系感染。存在术中并发症的肾脏术后更易发生高等级并发症(χ^(2)=5.600,P=0.018)及泌尿系感染(χ^(2)=8.891,P=0.003)。腹腔镜组较开放组更易出现高等级(ClavienⅢb)术后并发症(χ^(2)=6.595,P=0.010)和除泌尿系感染以外的其他术后并发症(χ^(2)=10.289,P=0.001)。结论腹腔镜和开放离断式肾盂成形术治疗儿童UPJO性肾积水安全有效,两种手术方式的术后并发症发生率无差异。腹腔镜手术较开放手术应更加注意Objective To compare the perioperative complications and explore the potential factors contributing to the differences in complications between laparoscopic and open dismembered pyeloplasty for congenital ureteropelvic junction obstructive hydronephrosis in children.Methods Between July 2016 and December 2018,retrospective review was conducted for all children with ureteropelvic junction obstruction(UPJO)undergoing primary transperitoneal laparoscopic pyeloplasty(LP)and retroperitoneal open pyeloplasty(OP)Perioperative complications were compared between LP and OP.Complication rate,Clavien-Dindo grade and types were compared.Complications were also compared between different postoperative drainage modes and groups with or without intraoperative complications.Also the differences in postoperative complications were explored among groups with varying age,weight,anterioposterior pelvic diameter(APD)and surgeon expertise.Results For 583 UPJO kidneys,LP was performed for 355 kidneys and OP for 228 kidneys.The median age of the open group was 16.37 months(9.73 months,61.37 months)and the median weight was 11.00 kg(9.30 kg,20.00 kg),which were significantly lower than the median age of the laparoscopic group,which was 46.87 months(19.08 months,90.49 months),and the median weight of 16.50 kg(12.00 kg,25.00 kg).The median preoperative renal pelvis anteroposterior diameter in the open group was 39.00 mm(27.00 mm,52.00 mm),significantly larger than that of the laparoscopic group,which was 28.00 mm(22.00 mm,36.00 mm).These differences were statistically significant(P<0.05).The inter-group incidence of intraoperative complications showed no significant difference(LP:7.61%vs OP:4.39%).Also no significant inter-group difference existed in restenosis of anastomotic rate(LP:2.62%vs.OP:1.33%).Although no significant inter-group difference in the incidence or frequency of postoperative complications,types of complications differed.Urinary tract infections(UTIs)dominated in both groups.Kidneys with intraoperative complications were

关 键 词：肾盂输尿管连接处梗阻 腹腔镜检查 泌尿外科手术 肾积水 手术中并发症 手术后并发症 儿童 

分 类 号：R726.9[医药卫生—儿科]