单孔气膀胱腹腔镜Politano-Leadbetter术治疗青少年原发性梗阻型巨输尿管的疗效分析  

Efficacy analysis of single-port intravesical laparoscopic Politano-Leadbetter for primary obstructive megaureter in adolescents

作　　者：肖智祥 何少华[1] 徐迪[1] 康映泉[1] 李鋆 Xiao Zhixiang;He Shaohua;Xu Di;Kang Yingquan;Li Jun(Department of Pediatric Surgery,Provincial Clinical Medical College of Fujian Medical University,Fujian Provincial Hospital,Fuzhou 350001,China)

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

出　　处：《中华泌尿外科杂志》2021年第11期844-848,共5页Chinese Journal of Urology

摘　　要：目的探讨单孔气膀胱腹腔镜Politano-Leadbetter术治疗青少年原发性梗阻型巨输尿管的疗效。方法回顾性分析2018年1月至2019年11月福建省立医院采用单孔气膀胱腹腔镜Politano-Leadbetter术治疗的11例青少年原发性梗阻型巨输尿管患者的临床资料。男7例,女4例;年龄(13.5±2.4)岁;体重(49.4±11.2)kg;左侧输尿管狭窄8例,右侧狭窄3例。术前患侧肾盂前后径(3.25±0.69)cm,输尿管最大径(2.25±0.48)cm,患肾皮质厚度(1.34±0.52)cm,分肾功能(36.00±2.86)%。所有患者均行单孔气膀胱腹腔镜Politano-Leadbetter术。术中采用耻骨上膀胱入路,建立单孔气膀胱通道,进行输尿管末端游离及裁剪、膀胱黏膜下隧道建立及输尿管末段重新包埋等,完成Politano-Leadbetter输尿管再植术。术后随访患侧肾盂、输尿管扩张迂曲程度及患肾分肾功能变化。结果本组11例手术均顺利完成。手术时间(95.6±18.5)min,术中出血量(6.8±2.3)ml,术后留置导尿管时间(4.5±1.8)d,住院时间(6.2±2.4)d。术后随访时间(13.6±4.3)个月。术后12个月患侧肾盂前后径(2.00±0.45)cm,输尿管最大径(1.18±0.22)cm,均较术前明显减少,差异均有统计学意义(P<0.05);患肾皮质厚度(2.17±0.49)cm,分肾功能(44.00±1.41)%,均较术前明显增加,差异均有统计学意义(P<0.05)。11例利尿肾图提示患侧非机械性梗阻或无梗阻曲线。1例术后6周出现泌尿系感染,予拔除双J管后恢复正常;另1例术后6、12个月均出现膀胱输尿管Ⅰ度反流,未出现泌尿系感染及腰痛症状。余患儿均恢复良好,无术后并发症。家长均对切口满意。结论单孔气膀胱腹腔镜Politano-Leadbetter术治疗青少年原发性梗阻型巨输尿管,可改善肾盂输尿管扩张积水及患肾的分肾功能,克服因青少年耻骨上方膀胱区脂肪垫肥厚、常规气膀胱腹腔镜手术易损伤的困难,手术效果理想,并发症少,安全、可行。Objective To investigate the efficacy of single-port intravesical laparoscopic Politano-Leadbetter in the treatment of adolescent primary obstructive megaureter.Methods Retrospective analysis was performed on the clinical data of 11 adolescents with primary obstructive megaureter who received single-port intravesical laparoscopic Politano-Leadbetter in Fujian Provincial Hospital from January 2018 to November 2019,including 7 males and 4 females,8 patients with left stenosis and 3 patients with right stenosis.The mean age was(13.5±2.4)years old,and the mean weight was(49.4±11.2)kg.Before surgery,the anteroposterior diameter of the affected renal pelvis was(3.25±0.69)cm,the maximum diameter of the ureter was(2.25±0.48)cm,the thickness of the affected renal cortex was(1.34±0.52)cm,and the renal function was(36.00±2.86)%.All patients underwent Politano-Leadbetter by single-port intravesical laparoscopic.Suprapubic bladder approach was used to establish a single-hole air bladder channel,and the end of the ureter was dislocated and cut,the submucosal tunnel of the bladder was established,and the end of the ureter was re-embedded.The Politano-Leadbetter ureteral replantation was completed.The dilatation and tortuousness of the affected renal pelvis and ureter and the changes of renal function of the affected kidney were analyzed before and after operation.Results All operations were completed successfully.The operative time was(95.6±18.5)min,the intraoperative blood loss was(6.8±2.3)ml,the postoperative indwelling catheter time was(4.5±1.8)d,and the average hospital stay was(6.2±2.4)d.Postoperative follow-up time was(13.6±4.3)months.12 months after surgery,the anteroposterior diameter of the affected renal pelvis and the maximum diameter of the ureter were(2.00±0.45)cm and(1.18±0.22)cm,which were significantly lower than those before surgery(P<0.05).The thickness of the renal cortex was(2.17±0.49)cm,and the renal function was(44.00±1.41)%,which was significantly increased compared with that before operati

关 键 词：输尿管梗阻 原发性巨输尿管 单孔 青少年 气膀胱腹腔镜 

分 类 号：R726.5[医药卫生—儿科]