单根输尿管膀胱再植术与输尿管端侧吻合术治疗小儿输尿管重复畸形的疗效对比研究  

Comparison of single ureteral reimplantation and ipsilateral ureteroureterostomy for ureteral duplication in Children

作　　者：王锦斌 方晓亮[1] 陈周彤 耿红全[1] Wang Jinbin;Fang Xiaoliang;Chen Zhoutong;Geng Hongquan(Department of Pediatric Urology,Affiliated Xinhua Hospital,Shanghai Jiao Tong University School of Medicine,Shanghai 200082,China;Department of Pediatric Urology,Municipal Women&Children's Hospital,Qingdao 266034,China)

机构地区：[1]上海交通大学医学院附属新华医院小儿泌尿外科,上海200082 [2]山东省青岛妇女儿童医院小儿泌尿外科,青岛266034

出　　处：《临床小儿外科杂志》2022年第4期341-346,共6页Journal of Clinical Pediatric Surgery

基　　金：国家自然科学基金(81770702)。

摘　　要：目的比较单根输尿管膀胱再植术与输尿管端侧吻合术治疗小儿输尿管重复畸形的安全性与疗效。方法回顾性分析2010年1月至2018年12月上海交通大学医学院附属新华医院收治的采用单根输尿管膀胱再植术与输尿管端侧吻合术治疗的小儿输尿管重复畸形患儿临床资料。共92例患儿,其中实施单根输尿管膀胱再植术42例,为单根输尿管膀胱再植术组,输尿管端侧吻合术50例,为输尿管端侧吻合术组。比较两组手术时间、术后住院天数、患侧肾盂前后径、患侧输尿管直径、患肾分肾功能、术后并发症等情况。结果单根输尿管膀胱再植术组手术时间显著少于输尿管端侧吻合术组(Z=-2.28,P=0.023),置入输尿管支架管病例数多于输尿管端侧吻合术组(χ^(2)=26.799,P<0.0001)。两组术后平均住院时间差异无统计学意义(Z=-1.639,P=0.101)。单根输尿管膀胱再植术组出现远期并发症2例(尿路感染、吻合口狭窄各1例),输尿管端侧吻合术组出现远期并发症4例(吻合口狭窄2例、尿路感染和膀胱输尿管反流各1例),差异无统计学意义(χ^(2)=0.041,P=0.839)。两组手术前后患肾部肾盂前后径、输尿管直径、分肾功能均有显著改善,手术前后患肾部肾盂前后径改善值ΔAPD(t=0.021,P=0.983)、分肾功能改善值ΔDRF(Z=-1.859,P=0.063)差异无统计学意义,两组手术前后患侧输尿管直径改善值ΔUD(t=2.697,P=0.008)差异有统计学意义。结论单根输尿管膀胱再植术和输尿管端侧吻合术治疗小儿输尿管重复畸形均安全、有效。输尿管端侧吻合术不涉及膀胱,导管相关并发症更少。Objective To compare the safety and efficacy of single ureteral bladder replantation versus end-to-side ureteral anastomosis for pediatric duplication of ureteral malformations.Methods From January 2010 to December 2018,retrospective analysis of clinical data was performed for 92 children with duplication of ureteral malformation undergoing single ureteral bladder replantation(n=42)versus end-to-side ureteral anastomosis(n=50).Operative duration,postoperative length of hospitalization,anterioposterior diameter(APD)of renal pelvis,diameter of ureter of affected kidney,renal function of affected kidney and postoperative complications were compared between two groups.Results Operative duration of single ureteral bladder replantation group was significantly shorter than that of ureteral end-to-side anastomosis group(Z=-2.28,P=0.023)and number of cases with ureteral stent placement more than that of ureteral end-to-side anastomosis group(χ^(2)=26.799,P<0.0001);no significant inter-group difference existed in average postoperative hospitalization length(Z=-1.639,P=0.101);there were 2 cases of long-term complications[urinary tract infection(n=1),stoma stenosis(n=1)]in single ureter-bladder replantation group and 4 cases of long-term complications in end-to-side ureteral anastomosis group[anastomotic stenosis(n=2),urinary tract infection(n=1),vesicoureteral reflux(n=1)],the difference was not statistically significant(χ^(2)=0.041,P=0.839).APD of renal pelvis,diameter of ureter and renal function of affected kidney improved significantly in two groups before and after operation.No significant inter-group difference existed in changes of anterioposterior renal pelvis diameterΔAPD(t=0.021,P=0.983)and differential renal functionΔDRF(Z=-1.859,P=0.063)before and after operation.The change value of renal ureter diameterΔUD was statistically different(t=2.697,P=0.008).Conclusion Both single ureteral bladder replantation and end-to-side ureteral anastomosis are safe and effective for children with ureteral duplication.End-to

关 键 词：输尿管膀胱再植 输尿管-输尿管吻合 肾重复畸形 输尿管重复畸形 外科手术/方法 治疗结果 

分 类 号：R726.9[医药卫生—儿科]