经腰小切口肾盂成形术在小儿的应用及单中心随访  

Pyeloplasty via a mini flank incision in children： a single center experience

作　　者：汤梁峰[1] 陆良生[1] 沈剑[1] 刘颖[1] 王翔[1] 陆毅群[1] 毕允力[1] 阮双岁[1] 

机构地区：[1]复旦大学附属儿科医院泌尿外科,上海201102

出　　处：《中华小儿外科杂志》2015年第10期736-739,共4页Chinese Journal of Pediatric Surgery

基　　金：2014-2016年度国家临床重点专科项目（国卫办医函[2013]544）

摘　　要：目的回顾本单位开展经腰小切口肾盂成形术的围手术期并发症及手术效果，总结经验。方法总结本单位2009年1月至2014年5月进行的所有经腰小切口肾盂成形术的309例患儿（321侧肾脏）资料，分析随访结果。术前超声测定的肾盂宽度（肾盂前后径）（31．7±14．7）mm。根据同位素动态肾脏显像计算的肾小球滤过率（GFR），除对侧。肾脏发育不良4例及双肾积水12例不能以对侧作为参考外，共293例计算相对分。肾功能，术前患侧分肾功能平均值为（28．5±16．8）％。结果术后共有17例（17／309，5．5%）患儿发生一次或更多次尿路感染而需要静脉应用抗菌素；1例患儿发生吻合口漏，保留肾周引流3周后自行愈合；1例拔除双J管后积水增加行肾盂穿刺引流后吻合口自行恢复通畅；4侧（4／321，1．24％）因术后随访中肾积水持续增加，分肾功能持续下降，考虑吻合口狭窄而再次行肾盂成形术。术后263例（85．1％）患儿随访时间（1．93±1．35）年，共274侧肾脏，术后肾盂宽度（13．2±7．8）mm。除肾发育不良、再手术等无法以对侧为参照的患儿之外，232例随访同位素分肾功能的单侧术后患儿中，术前分。肾功能大于40％共40例，术后均无分肾功能下降；术前分肾功能小于40％共192例，术后分肾功能较术前上升大于5％共134例，术后分肾功能和术前相比改变小于5％共51例，分肾功能下降大于5％共7例。获得随访的11例双侧术后患儿全部获得术后分肾功能的好转。结论经腰小切口肾盂成形术安全有效，是治疗小年龄儿童肾盂输尿管连接处梗阻的合理手术方案。Objective To explore the perioperative complications and long-term outcomes of pyeloplasty via a miniflank incision. Methods Retrospective analyses were conducted for all clinical data of 309 patients （321 kidneys） undergoing pyeloplasty via a miniflank incision during January 2009 and May 2014. The preoperative ultrasonic pelvis width （anteroposterior diameter, APD） was 31.7 ± 14. 7 mm Preoperative average spilt renal function was calculated according to isotope scintigraphy. Except for contralateral kidney dysplasia （n = 4） and bilateral cases （n = 12）, 293 cases had an average value of renal function at 28.5 ± 16. 8%. Results And 17/309 cases （5.5%） suffered urinary tract infections requiring intravenous antibiotics. One case of anastomotic leakage healed after a 3-week perirenal drainage. Four patients （4 sides, 4/321, 1.24%） underwent re-operation of pyeloplasty because of anastomotic obstruction with increasing hydronephrosis and worsening renal function during postoperative follow-ups. And 263 cases （85.1%） had a mean follow up period of 1.93 ± 1.35 years. Pelvis width was 13.2 ± 7. 8 mm for a total of 274 kidneys. Except for kidney dysplasia and re- operative cases,232 cases received isotope scintigraphy for kidney function after operation. During the follow-ups,40 cases with over 40% of split renal function pre-operation showed no decline. In 192 cases with preoperative renal function under 40%, 51 cases had changes in split renal function of under 5% and 134 cases had split renal function increases of over 5%. However, split renal function decreased over 5 %in 7 cases. And 11 patients with bilateral hydronephrosis improved in renal function during the follow-ups. Conclusions Pyeloplasty via a miniflank incision is both safe and effective in the treatment of younger children with ureteropelvic junction obstruction.

关 键 词：肾盂输尿管连接处梗阻 肾盂成形术 外科手术 微创性 

分 类 号：R726.9[医药卫生—儿科]