开放小切口Anderson-Hynes术治疗小儿肾积水83例疗效分析  

Analysis of curative efficacy for open small incision Anderson-Hynes treatment of children with hydronephrosis:a report of 83 cases

作　　者：严兵[1] 张黄成昊 唐浩宇[1] 张昆[1] 武成闯[1] 夭志刚 Yan Bing;Zhanghuang Chenghao;Tang Haoyu;Zhang Kun;Wu Chengchuang;Yao Zhigang(Department of Urological Surgery,Municipal Children's Hospital&Yunnan Provincial Key Laboratory for Researches in Major Pediatric Diseases,Kunming 650101,China)

机构地区：[1]昆明市儿童医院泌尿外科,云南省儿童重大疾病研究重点实验室,云南省昆明市650101

出　　处：《临床小儿外科杂志》2020年第5期432-436,共5页Journal of Clinical Pediatric Surgery

基　　金：云南省教育厅科学研究基金(编号:2020J0228)。

摘　　要：目的探讨开放小切口Anderson-Hynes术治疗小儿肾盂输尿管连接部狭窄(ureteropelvic junction obstruction,UPJO)所致肾积水的有效性及临床应用价值。方法回顾性分析2016年7月至2017年6月昆明市儿童医院泌尿外科因肾积水行开放性Anderson-Hynes术患儿的临床资料,结合国内外最新Anderson-Hynes术相关文献报道,从手术时间、术中出血量、住院天数、术后并发症发生情况等方面评价其疗效。结果本研究共纳入83例患儿,年龄31日龄至8岁,平均(2.1±1.9)岁;左侧47例,右侧28例,双侧8例;因积水加重行二次手术3例,取管后反复尿路感染3例,取管后积水未减轻1例;手术时间45~165 min,平均(95.2±26.5)min;术中出血量2~15 m L,平均(6.9±3.5)m L;住院天数5~28 d,平均(12.2±4.2)d。5例因尿外渗及输尿管长段狭窄而延迟至术后3个月取出双J管,其余患儿均于术后1个月取管,无一例发生管位回缩及结石形成;随访6个月至3年。术前肾盂前后径(anterior and posterior diameter of renal pelvis,APD)较术后缩短[(44.2±18.4)mm vs.(16.1±9.6)mm,P<0.001];术后最小肾皮质厚度较术前增厚[(9.3±1.4)mm vs.(4.2±2.0)mm,P<0.001],患儿均成功解除梗阻,临床症状消失。结论开放小切口Anderson-Hynes术疗效确切,学习曲线短,硬件设施要求低,在不具备腹腔镜设备的二级和三级医院值得推广。Objective To explore the effectiveness and necessity of pyeloureteroplasty for ureteropelvic junction obstruction in infants and toddlers.Methods The clinical data were retrospectively reviewed for 83 children undergoing open Anderson-Hynes procedure for hydronephrosis from July 2016 to June 2017.In conjunctions with the recent domestic and international literatures,the curative efficacy was evaluated from the perspectives of operative duration,amount of intraoperative hemorrhage,days of hospitalization and occurrences of postoperative complications.Results The average age was(2.1±1.9)years.The involved side was left(n=47),right(n=28)and bilateral(n=8).There were re-operation for aggravated hydrops(n=3),recurrent urinary tract infection(n=3)and non-relief of hydronephrosis after extraction(n=1).The average operative duration was(45-165)(95.2±26.5)min,the average volume of blood loss(2-15)(6.9±3.5)ml and the hospitalization duration(5-28)(12.2±4.2)days.Removing double-J tube was delayed until 3 months due to urinary extravasation and long-segment ureteral obstruction of ureter(n=5).For the remainder,removal occurred at 1 month post-operation.No tube retraction or stone occurred during a mean follow-up period of 1.7(0.5-3)years.The anterior and posterior diameter of renal pelvis decreased postoperatively[(44.2±18.4)versus(16.1±9.6)mm,P<0.001].And the postoperative renal cortical thickness was greater than the preoperative counterpart[(9.3±1.4)versus(4.2±2.0)mm,P<0.001].All obstructions were successfully relieved.The symptoms were alleviated and the clinical symptoms disappeared.Conclusion With a short learning curve,open small incision Anderson-hynes procedure is effective.Its requirement of hardware facilities is low so that it is worth wider popularization at secondary and tertiary hospitals without laparoscopic equipment.

关 键 词：肾积水 Anderson-Hynes术 治疗 儿童 

分 类 号：R726.9[医药卫生—儿科] R692.2[医药卫生—临床医学]