经尿道钬激光开窗治疗儿童重复肾合并输尿管囊肿  

Transurethral Fenestration with Holmium Laser for Duplex Kidney Combined with Ureterocele in Children

作　　者：张殷[1,2] 潮敏 沈剑 蒋加斌 张晔 方向 张开平 张贤生 ZHANG Yin;CHAO Min;SHEN Jian;JIANG Jia-bin;ZHANG Ye;FANG Xiang;ZHANG Kai-ping;ZHANG Xian-sheng(Department of Urology,The First Affiliated Hospital of Anhui Medical University,Hefei,230022,China;Department of Urology,Anhui Provincial Children’s Hospital/Children’s Hospital of Fudan University Affiliated Anhui Branch,Hefei,230051,China;Department of Urology,Children’s Hospital of Fudan University,Shanghai,201102,China)

机构地区：[1]安徽医科大学第一附属医院泌尿外科,安徽合肥230022 [2]安徽省儿童医院//复旦大学附属儿科医院安徽医院泌尿外科,安徽合肥230051 [3]复旦大学附属儿科医院泌尿外科,上海201102

出　　处：《中山大学学报（医学科学版）》2021年第4期563-570,共8页Journal of Sun Yat-Sen University:Medical Sciences

基　　金：国家自然科学基金(82071637);安徽省儿童医院重点专科项目(20186212);安徽医科大学校科研基金(2019xkj184)。

摘　　要：【目的】探讨经尿道钬激光开窗作为儿童重复肾合并输尿管末端囊肿的初始治疗方案的疗效。【方法】回顾性分析2016年1月至2020年12月手术治疗的35例重复肾伴有输尿管末端囊肿的患儿的临床资料。根据初始治疗方案的不同分为A、B两组。A组采用膀胱镜下钬激光输尿管囊肿开窗术。B组采用上、下尿路重建手术,对远端输尿管囊肿旷置。分析病例的月龄、性别、上尿路状况、输尿管囊肿位置、术前和术后膀胱输尿管反流情况、术后需要额外手术的并发症情况,并进行统计学分析。【结果】A组术后有13例囊肿缩小且积水减轻,4例囊肿完全消失,8例出现新发膀胱输尿管反流,5例在术后的3~6月经历了再次手术,其中4例因新发反流造成反复感染进行了输尿管膀胱再植手术,1例为囊肿壁塌陷造成排尿困难,进行了上半肾切除和膀胱镜下囊肿部分切除手术。B组术后有9例恢复良好,有4例在术后的6~12月经历了再手术治疗。其中1例因再植术后输尿管末端梗阻经历了再次的输尿管再植手术,另3例为上半肾切除术后输尿管残端综合征进行了输尿管膀胱再植手术。A、B两组相比,平均手术时间(31.77±13.43)min vs.(174.46±37.79)min,t=-13.131,P=0.000,和术后住院天数(2.27±1.93)d vs.(11.54±7.33)d,t=-4.465,P=0.001,差异有统计学意义,A、B两组早期的再手术率上无统计学差异,Fisher检验P=0.698。【结论】对于重复肾伴有输尿管末端囊肿的低龄儿童患者,膀胱镜下钬激光输尿管囊肿开窗手术可以作为初始的治疗方案。【Objective】To investigate the efficacy of transurethral fenestration with holmium laser as the initial management for duplex kidney associated with ureterocele in children.【Methods】The clinical data of 35 children with duplex kidney and ureterocele who underwent surgical treatment in our department from January 2016 to December 2020 were retrospectively analyzed.According to the different initial treatment options,the subjects were divided into two groups:transurethral fenestration by holmium:YAG laser(group A)and single-port laparoscopic heminephrectomy and transperitoneal single-port laparoscopic ureterovesical replantation(group B).Group A(n=22)received endoscopic holmium laser ureterotomy and group B(n=13)underwent kidney or bladder level reconstruction and ureterocele exclusion surgery.The age,gender,upper urinary tract condition,location of ureterocele,preoperative and postoperative vesicoureteral reflux,postoperative complications requiring additional surgery were recorded and statistically analyzed.【Results】In group A,13 cases had cyst crumpled and hydronephrosis subsided,4 cases had completely disappeared cysts,de novo vesicoureteral reflux occurred in 8 cases,5 cases underwent reoperation 3~6 months after operation,among which 4 cases underwent ureterovesical replantation because of urinary tract infection by de novo vesicoureteral reflux,1 case received heminephrectomy and cystoscopic cystectomy because of the cyst collapse.In group B,9 cases had favorable prognosis,4 cases underwent reoperation from 6 to 12 months after operation,among which 1 case underwent replantation due to postoperative anastomotic obstruction,3 cases underwent replantation due to ureteral stump syndrome.The mean operation time between group A and B was(31.77±13.43)min vs.(174.46±37.79)min,t=-13.131,P=0.000;the mean hospital stay was(2.27±1.93)d vs.(11.54±7.33)d,t=-4.465,P=0.001,and the difference was statistically significant.There was no significant difference in the early reoperation rate between the two groups

关 键 词：钬激光 输尿管囊肿 重复肾输尿管 微创 开窗术 儿童 

分 类 号：R693[医药卫生—泌尿科学]