儿童肾盂成形术后再梗阻原因及再次行腹腔镜手术的可行性  

Reoperative laparoscopic surgery in children with failed pyeloplasty

作　　者：曹华林[1] 周辉霞[3] 王蕊 马立飞 刘德鸿 周晓光 陶天 罗小龙 张岩 宋百乐 

机构地区：[1]南方医科大学研究生学院,广州510515 [2]解放军陆军总医院附属八一儿童医院泌尿外科 [3]南方医科大学

出　　处：《中华泌尿外科杂志》2017年第5期362-366,共5页Chinese Journal of Urology

基　　金：首都卫生发展科研专项（2016-2-5091）;国家公益性行业科研专项基金（201402007）

摘　　要：目的探讨儿童初次肾盂成形术后再梗阻的原因及再次行腹腔镜手术治疗的可行性。方法回顾性分析我院2009年9月至2016年6月收治的39例肾盂成形术后再梗阻患儿的临床资料。男31例，女8例。年龄4～204个月，平均66个月。病变位于左侧28例，右侧11例。所有患儿术前均行泌尿系B超、MRU及MAG3肾核素扫描等检查明确诊断为肾盂输尿管连接部梗阻。全麻下行腹腔镜下探查术，发现梗阻原因为肾盏狭窄2例（5．1％），遗留病变输尿管组织＋吻合口狭窄4例（10．3％），粘连带压迫＋吻合口狭窄2例（5．1％），输尿管扭转＋粘连带压迫＋输尿管高位吻合l例（2．6％），单纯吻合口狭窄30例（76．9％）。39例均行腹腔镜手术，其中行肾盂成形术33例，阑尾镶嵌输尿管成形术5例，输尿管肾下盏吻合术1例。结果39例手术均顺利完成，无中转开放手术，无术中并发症。1例拔除双J管后出现反复腰疼1d，超声检查提示重度肾积水，最终行肾切除术；1例术后2个月拔除双J管后复查超声、MRU等提示重度肾积水，再次行阑尾镶嵌输尿管成形术后治愈；1例术后吻合口粘连行输尿管球囊扩张术后治愈。其余36例患儿术后症状均缓解。随访3～60个月，平均25个月，影像学检查均提示无梗阻表现，手术成功率为92．3％（36／39）。结论遗留病变输尿管组织、吻合口狭窄、肾盏狭窄、粘连带压迫、输尿管扭转及高位输尿管吻合均可导致患儿肾盂成形术后再梗阻。对初次肾盂成形术后再梗阻患儿再次行腹腔镜手术是安全、可行的。Objective To investigate the etilolgy of failed pyeloplasty in children and to study the feasibility of redo laparoscopic surgery for recurrent ureteropelvic junction obstruction. Methods The clinical data of 39 patients with recurrent ureteropelvic junction obstruction after the primary pyeloplasty underwent redo laparoscopic surgery were analyzed retrospectively between September 2009 and June 2016 in our institution. There were 31 males and 8 females with a mean age of 66 months, ranged from 4 to 204 months. 28 patients had left obstructions and 11 had right obstructions, who were diagnosed by uhrasonography, MRU, and MAG3 renal scan et al. Under general anesthesia, we identified that two patients （5.1% ） had renal calices strictures, four patients （ 10. 3% ） had unsolved disease ureter and anastomotic strictures, two patients （5.1% ） had adhesion band and anastomotie strictures, one patient had adhesion band, high ureteropelvic anastomosis and ureter torsion, and 30 （76. 9% ） patients had anastomotic strictures. Thirty-three patients underwent dismembered pyeloplasty, five patients underwent on- lay appendiculoureteroplasty and one patient underwent ureterocalicostomy. Results All surgeries were successfully completed without conversion. No intraoperative complication was encountered. One patient had persistent, frequent and intolerable flank pain with severe hydronephrosis after surgery, he subsequently underwent nephrectomy. One patient bad persistent severe hydronephrosis which was repaired with on-lay appendiculoureteroplasty. One patient had anastomotic adhesion and balloon dilatation was performed with no further obstruction in follow up imaging. The rest of the patients got complete clinical or radiologic resolution. The successive rate was 36 of 39 （92. 3% ） at a mean follow up of 25 months（ ranging 3 -60 months）. Conclusions Unsolved ureterie pathologies, anastomotic stricture, renal ealices stricture, adhesion band, torsion of ureter and high ureteropelvic anastomosis all con

关 键 词：再次 腹腔镜 肾盂输尿管成形术 儿童 肾积水 

分 类 号：R726.9[医药卫生—儿科]