单侧重复肾合并异位输尿管膨出患儿术后并发症危险因素分析  

Special Topics on Diagnosing and Treating Duplex Kidney Risk factors for postoperative complications in children with ectopic obstructing ureterocele in complete duplex kidney

作　　者：殷晓鸣[1] 杨屹[1] Yin Xiaoming;Yang Yi(Department of Pediatric Urology,Affiliated Shengjing Hospital,China Medical University,Shenyang 110004,China)

机构地区：[1]中国医科大学附属盛京医院小儿泌尿外科,沈阳110004

出　　处：《中华小儿外科杂志》2020年第7期596-601,共6页Chinese Journal of Pediatric Surgery

基　　金：国家自然科学基金(81571514)。

摘　　要：目的:分析单侧完全重复肾合并梗阻性异位输尿管末端膨出患儿术后出现并发症的危险因素。方法:2008年1月至2019年6月在中国医科大学附属盛京医院行手术治疗的单侧完全重复肾合并梗阻性异位输尿管末端膨出患儿共74例。74例患儿中13例患儿被排除。61例患儿纳入分析,其中男8例,女53例,分为2组,术后出现并发症(并发症组)23例和术后未出现并发症(无并发症组)38例。本研究患儿纳入标准:单侧完全重复肾合并梗阻性异位输尿管末端膨出的患儿,术后随访时间半年以上,患儿年龄≤14岁。本研究患儿排除标准:术前存在膀胱输尿管反流,重复肾下肾发育异常,重复肾对侧肾脏发育异常。所有患儿术前1个月内行泌尿系统超声检查,排尿性膀胱尿道造影(voiding cystourethrogram,VCUG)以及利尿肾图检查(造影剂为DTPA或EC)。如患儿术前出现尿线细,排尿无力或排尿滴沥,则术前需要完善尿流动力学检查。异位膨出的确定由术前VCUG及术前膀胱镜检查确定。当术前上肾分肾功能<10%,可行上位肾切除术、输尿管末端膨出电切或穿刺术以及输尿管膀胱移植术,但是具体手术方式的选择由手术医生及患儿家长共同决定。当术前上肾分肾功能≥10%,行输尿管末端膨出电切/穿刺或输尿管膀胱移植手术,术式选择由手术医生及家长共同决定。结果:61例患儿中首次行经尿道输尿管末端膨出电切或穿刺35例,行腹腔镜上位肾切除23例,行输尿管膀胱移植术3例。术后23例出现并发症,包括21例新发膀胱输尿管反流,1例膀胱出口梗阻,1例日间尿失禁。61例患儿中5例行二次手术治愈,再手术率为8.2%(5/61)。21例出现术后新发膀胱输尿管反流患儿中,12例出现同侧上肾反流,7例同侧下肾反流,2例对侧反流;9例自行缓解,8例为无症状持续Ⅰ~Ⅱ度反流,4例出现Ⅳ度反流合并突破性泌尿系统感染,行输尿管膀胱移植术后�Objective To explore the risk factors for postoperative complications in children with ectopic obstructing ureterocele in complete duplex kidney.Methods From January 2008 to June 2019,there were a total of 74 postoperative children with unilateral complete duplex kidney associated with obstructive ectopic ureterocele.After excluding 13 cases,61 children were recruited.There were 8 boys and 53 girls.The involved side was left(n=33)and right(n=28).They were divided into 2 groups with postoperative complication(n=23)or without complication(n=38).The median operative age was 15(6.5-34.0)months.Inclusion criteria:unilateral complete duplex kidney associated with obstructive ectopic ureterocele,follow-up period more than half a year postoperative and age≤14 years;Exclusion criteria:preoperative vesicoureteral reflux,abnormal lower moiety and contralateral kidney.Urinary ultrasonography,voiding cystourethrogram(VCUG)and diuretic nephrogram(DTPA/EC)were performed within 1 month postoperative.If there was a thin urinary line,weak urination or postoperative urination dripping,urodynamic test must be performed.Ectopic ureterocele was confirmed by preoperative VCUG and cystoscopy.When preoperative split renal function of upper moiety was<10%,heminephrectomy,endoscopic ureterocele incision/puncture or ureteral reimplantation was performed.And the options of surgical approaches were determined by surgeons and guardians.When preoperative split renal function of upper moiety was>10%,endoscopic ureterocele incision/puncture or ureteral reimplantation was performed.And the options of surgical approaches were determined by surgeons and parents.Results The procedures included endoscopic ureterocele incision/puncture(n=35),laparoscopic heminephrectomy(n=23)and ureteral reimplantation.And 23/61(37.7%)children had postoperative complications of de novo vesicoureteral reflux(n=21),daytime urinary incontinence(n=1)and bladder outlet obstruction(n=1).And 5/23 were re-operated with a re-operative rate of 8.2%.Among 21 children of de novo

关 键 词：儿童 重复肾 输尿管膨出 并发症 危险因素 

分 类 号：R726.9[医药卫生—儿科]