微小切口治疗1岁以下婴儿肾积水90例分析  

Mini-invasive pyeloplasty for infants aged under 1 year:a report of 90 cases with a literature comparison

作　　者：王子林 刘欣健 景登攀 马建琦 陶德赏 杨琨琨[2] 翟荣群 文建国[2] 

机构地区：[1]开封市儿童医院泌尿外科,河南省开封市475000 [2]郑州大学第一附属医院小儿尿动力学中心,河南省临床医学重点学科开放实验室,河南省郑州市450052

出　　处：《临床小儿外科杂志》2016年第4期340-343,共4页Journal of Clinical Pediatric Surgery

基　　金：国家自然科学基金项目;项目号:81370869

摘　　要：目的：探讨微小切口离断性肾盂成形术治疗婴儿先天性肾积水的有效性和安全性。方法回顾性分析2010年5月至2015年6月本院收治的90例1岁以下先天性单侧婴儿肾积水患者临床资料，患儿年龄1～12个月，平均年龄（5．98＆#177;2．87）个月，经 B 超确诊肾盂扩张大于3 cm，有不明原因的哭闹、腹痛等临床症状，观察3个月，静脉肾盂造影与 CTU 检查支持肾盂输尿管交界处不全梗阻（PUJO）。于术后3个月、6个月、12个月随访。我们将本研究中的手术时间、并发症和手术成功率和文献报道的腹腔镜手术治疗同龄婴儿肾积水数据进行比较。结果90例手术均获成功，无因切口较小需扩大切口进行手术病例，平均手术时间显著少于文献报道的同龄婴儿腹腔镜手术时间（91．2±177;9．4） min vs （178．5±177;9．1）min ，P ＜0．01。4例术后出现尿路感染。而文献报道病例组7例出现手术并发症（尿路感染3例，局部出血1例，肾盂输尿管吻合口尿瘘1例，其他2例），3例术后肾盂输尿管连接处梗阻复发，手术失败。本组手术和文献中腹腔镜下肾盂成形术相比，在手术成功率、术后并发症方面无明显差别。结论微小切口离断性肾盂成形术尤其适用于治疗1岁以下婴儿肾积水，值得临床推广。Objetive To compare the efficacies of laparoscopic-assisted dismembered pyeloplasty （LADP ） versus mini-invasive pyeloplasty for congenital hydronephrosis in infants aged under 1 year. Methods From May 2010 to June 2015,90 infants with unilateral congenital hydronephrosis undergo-ing mini-invasive pyeloplasty were retrospectively analyzed.The mean age was 5.78 ＆#177;2.47 （1 ~12）months. All cases were diagnosed by ultrasound,intravenous pyeloplasty （IVP）and renogram.The parameters of oper-ative duration,postoperative complications and success rate were compared to 83 age-matched patients in 4 lit-erature series of LADP from between 2007 and 2014. Results Patient demographics were similar for two groups.However,mean operative duration was significantly shorter in mini-invasive pyeloplasty group than that of LADP （91.2 vs 178.5 min,P ＆lt;0.01）.And no significant inter-group difference existed in success rate or postoperative complications. Conclusions Mini-invasive pyeloplasty is both safe and effective for unilateral congenital hydronephrosis in infants aged under 1 year.

关 键 词：肾盂积水 腹腔镜检查 外科手术 微创性 治疗 

分 类 号：R726.9[医药卫生—儿科]