儿童肾盂输尿管成形术后不同引流方式的比较研究  

Comparison of different drainage methods after ureteroplasty in children

作　　者：黄一天 杨猛 温晟[1,2,3,4] 何大维 魏光辉[1,2,3,4] 林涛 张德迎[1,2,3,4] 刘星 刘丰[1,2,3,4] 吴盛德 石艳[1] 倪园松 何佩儒[1] 华燚 Huang Yitian;Yang Meng;Wen Sheng;He Dawei;Wei Guanghui;Lin Tao;Zhang Deying;Liu Xing;Liu Feng;Wu Shengde;Shi Yan;Ni Yuansong;He Peiru;Hua Yi(Department of Urology,Children's Hospital,Chongqing Medical University,Chongqing 400014,China;National Clinical Research Center for Child Health&Disorders,Chongqing 400014,China;Ministry of Education Key Laboratory of Child Development&Disorders,Chongqing 400014,China;Chongqing Key Laboratory of Pediatrics,Chongqing 400014,China)

机构地区：[1]重庆医科大学附属儿童医院泌尿外科,重庆市400014 [2]国家儿童健康与疾病临床医学研究中心,重庆市400014 [3]儿童发育疾病研究教育部重点实验室,重庆市400014 [4]儿科学重庆市重点实验室,重庆市400014

出　　处：《临床小儿外科杂志》2021年第3期247-252,共6页Journal of Clinical Pediatric Surgery

基　　金：重庆市渝中区基础研究与前沿探索项目(编号:20200151)。

摘　　要：目的探讨腹腔镜下肾盂输尿管成形术后的最佳引流方式。方法以2016年1月至2019年12月重庆医科大学附属儿童医院收治的165例接受经腹入路腹腔镜下Anderson-Hynes肾盂成形术治疗的肾积水患者为研究对象,根据不同引流方式分为双J管组和支架管组,双J管组采用常规术中输尿管,置入双J管引流肾盂内尿液至膀胱(n=108);支架管组采用F4输尿管支架管经肾盂至尿道外口,引流肾盂内尿液至体外(n=57)。通过术后并发症、有无非计划再手术、拔管后自觉症状、术后住院时间以及住院费用等指标,评价两种不同引流方式在儿童肾盂输尿管成形术中的疗效。结果所有患者从术后随访至2019年12月,随访时间为2个月至4年。支架管组中4例发生术后感染,3例术后出现尿外渗,4例出现术后血尿;双J管组中7例发生术后感染,2例术后出现尿外渗,2例出现术后血尿,上述指标差异均无统计学意义(P>0.05)。但在总体并发症发生率上,双J管组低于支架管组。支架管组中4例因拔管后出现输尿管引流不畅,再次行输尿管支架管置入术;2例因肾积水复发,再次行肾盂输尿管成形术。双J管组中有4例术后感染,1例双J管堵塞,均行双J管拔除+输尿管支架管置入术,1例因肾积水复发再次行肾盂输尿管成形术。支架管组总体非计划再手术率为10%,双J管组为5%,差异无统计学意义(P>0.05)。双J管组中,1例管腔堵塞,2例支架管上移,1例双J管脱出体外,支架管组无一例管腔堵塞、移位及脱落情况发生,差异无统计学意义(P>0.05)。支架管组中拔管后,1例出现腹胀合并高血压,8例出现腹胀伴纳差,2例出现腹痛,双J管组拔管后有2例出现腹痛,1例出现腹胀。支架管组拔管后总体不良反应发生率为19.2%,双J管组为2.7%,差异有统计学意义(P<0.05)。双J管组平均住院时间为(5.8±1.9)d,支架管组为(8.8±2.3)d,差异有统计学意义(P<0.05)。结论双J管和�Objective To explore the optimal drainage method after laparoscopic pelvic ureteroplasty.Methods From January 2016 to December 2019,a total of 165 hydronephrotic children undergoing Anderson-Hynes pyeloplasty under laparoscopic peritoneal approach were divided into two groups.Group A:conventional intraoperative ureter was employed and a double J tube inserted for draining urine from renal pelvis to bladder(double J tube group,n=108);group B:a F4 ureteral stent tube was deposited through renal pelvis to outer urethra to drain urine from renal pelvis to body(stent tube group,n=57).With the indicators of postoperative complications,unplanned reoperation,post-extubation symptoms,postoperative hospital stay and hospitalization costs,the efficacy was evaluated for two different drainage methods after pyeureteroplasty.Results The postoperative follow-up period was until December 2019.The longest follow-up time was 48 months and the shortest 2 months.In stent tube group,there were postoperative infection(n=4),urinary extravasation(n=3)and postoperative hematuria(n=4);in double J tube group,postoperative infection(n=7),urinary extravasation(n=2)and postoperative hematuria(n=2).No significant difference existed in the above indicators(P>0.05).However,the overall complication rate was lower in double J tube group than stent tube group.In stent group,4 cases underwent ureteral stenting for poor ureteral drainage after extubation;ureteroplasty was performed for 2 cases due to recurrent hydronephrosis.In double J tube group,there were postoperative infection(n=4)and double J tube blockage(n=1).All underwent double J tube removal plus ureteral stenting and one case of recurrent hydronephrosis underwent pyeloplasty.The overall unplanned reoperative rate was 10% in stent tube group and 5% in double J tube group and the difference was not statistically significant(P>0.05).In double J tube group,there were lumen blockage(n=1),upward movement of stent tube(n=2)and prolapse of double J tube(n=1).There was no lumen blockage,displaceme

关 键 词：肾盂输尿管连接处狭窄/外科学 肾积水/外科学 引流术 治疗结果 

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