改良气膀胱腹腔镜Politano-Leadbetter术在儿童输尿管膀胱再植中的应用  

Application of modified transvesicoscopic Politano-Leadbetter laparoscopy during ureteral reimplantation using pneumovesicum in children

作　　者：林珊[1] 许辉煌[1] 李立帜[1] 何少华[1] 汤坤彬 徐迪[1] Lin Shan;Xv Huihuang;Li Lizhi;He Shaohua;Tang Kunbin;Xv Di(Department of Pediatric Surgery,Fujian Provincial Hospital,Provincial Clinical Medical College of Fujian Medical University,Fuzhou 350001,China)

机构地区：[1]福建省立医院小儿外科,福建医科大学省立临床医学院,福州350001

出　　处：《中华小儿外科杂志》2021年第11期993-998,共6页Chinese Journal of Pediatric Surgery

摘　　要：目的探讨改良气膀胱腹腔镜Politano-Leadbetter术在治疗原发性膀胱输尿管反流及原发性梗阻型巨输尿管中的作用。方法回顾性分析2018年5月至2019年11月福建省立医院小儿外科收治的22例原发性膀胱输尿管反流(12例,原发性膀胱输尿管反流组)及梗阻型巨输尿管(10例,梗阻型巨输尿管组)患儿的临床资料。22例患儿均予改良气膀胱腹腔镜Politano-Leadbetter术进行治疗。比较两组患儿手术前、后各项参数变化,采用配对样本t检验进行统计学分析。结果22例患儿手术均获得成功,无中转开放者。术中出血量为(5.95±1.63)ml,单侧手术时间为(101.69±7.87)min,双侧手术时间为(136.00±7.83)min,留置导尿时间为(5.78±1.06)d,住院时间为(6.65±1.08)d。随访时间为(8.35±2.21)个月,范围在6~12个月。术后2个月内发生发热及尿路感染5例,均予抗感染保守治疗,拔除双J管后未再复发。术后2个月复查膀胱镜,输尿管口形态位置良好,3F输尿管导管经输尿管口逆行置管顺畅,证实输尿管经新输尿管裂孔进入膀胱处无折角;排泄性膀胱尿路造影检查均未见反流。术后6个月复查利尿肾图均未发现梗阻曲线。原发性膀胱输尿管反流组术后6个月输尿管最大直径、肾盂前后径分别为(8.08±1.78)mm和(16.25±2.83)mm,均较术前(10.08±2.11)mm和(21.08±2.71)mm明显减小;术后6个月肾皮质厚度为(6.96±1.81)mm,较术前(5.93±2.07)mm明显增厚;术后6个月分肾功能为(45.50±2.27)%较术前(42.50±3.03)%明显提高,上述参数前后时间点比较,差异均有统计学意义(P均<0.001)。梗阻型巨输尿管组术后6个月输尿管最大直径、肾盂前后径分别为(14.70±2.58)mm和(27.80±2.35)mm,均较术前(17.80±2.35)mm和(33.50±3.24)mm明显缩小;术后6个月肾皮质厚度为(7.67±2.48)mm,较术前(6.41±2.77)mm明显增厚;术后6个月分肾功能为(38.77±2.91)%较术前(36.04±3.55)%明显提高,上述参数前后时间点比较,差异均Objective To summarize our institutional experience of using modified transvesicoscopic Politano-Leadbetter laparoscopy for primary vesicoureteral reflux(VUR)and primary obstructed megaureter(POM)in children.Methods From May 2018 to November 2019,retrospective review was conducted for medical records of 22 children undergoing modified transvesicoscopic Politano-Leadbetter laparoscopy.They were assigned to two groups of primary VUR(A,n=12)and POM(B,n=10).Perioperative parameters and postoperative outcomes were compared.Paired sample T test was utilized for statistical analysis.Results All modified procedures were performed successfully.Intraoperative volume of blood loss was(5.95±1.63)ml,unilateral operative duration(101.69±7.87)min,bilateral operative duration(136.00±7.83)min,indwelling urethral catheter duration(5.78±1.06)days and hospitalization length(6.65±1.08)days.The follow-up period was(8.35±2.21)months.Five patients with urinary tract infections(UTIs)within 2 months postoperatively were conservatively treated.No recurrence occurred after removing double J tube.There were no other postoperative complications.All patients showed a decent ureteral orifice on cystoscopy and 3F ureteral stent could be easily passed into ureter.Voiding cystourethrogram(VCUG)was examined at 2 months postoperatively and none had reflux.Perioperative parameters and postoperative outcomes at Month 6 were compared.In group A,postoperative ureter diameter and renal pelvic diameter(APRPD)decreased markedly at post-operation compared to those at pre-operation[(8.08±1.78)mm and(16.25±2.83)mm vs.(10.08±2.11)mm and(21.08±2.71)mm,P<0.001].Parenchymal thickness and differential renal function(DRF)improved significantly[(6.96±1.81)mm and(45.50±2.27)%vs.(5.93±2.07)mm and(42.50±3.03)%,P<0.001].In group B,ureter diameter and APRPD declined markedly[(14.70±2.58)and(27.80±2.35)mm vs(17.80±2.35)and(33.50±3.24)mm)].Parenchymal thickness and differential renal function(DRF)improved significantly[(7.67±2.48)mm and(38.77±2.91)%vs.(

关 键 词：腹腔镜 膀胱输尿管反流 梗阻型巨输尿管 输尿管再植术 

分 类 号：R726.9[医药卫生—儿科]