气膀胱腹腔镜Cohen手术在输尿管末端疾病中的应用及疗效分析  

Application and effect analysis of pneumatic bladder laparoscopic Cohen operation in ureteral end diseases

作　　者：贺妍 许英蕊 刘兆全 吴学敏 杜国强 武翔宇 吴荣德[1] 刘伟[1] HE Yan;XU Yingrui;LIU Zhao-quan(Department of Pediatric Surgery,Shandong Provincial Hospital,Shandong University,Jinan 250021,China)

机构地区：[1]山东大学山东省立医院小儿外科,山东济南250021 [2]山东第一医科大学附属省立医院小儿外科

出　　处：《腹腔镜外科杂志》2023年第3期209-213,共5页Journal of Laparoscopic Surgery

摘　　要：目的:探讨气膀胱腹腔镜Cohen手术治疗输尿管末端疾病的疗效。方法:回顾分析2011年5月至2021年12月收治的膀胱输尿管反流及输尿管末端梗阻患儿的临床资料。患儿均行输尿管膀胱再植手术,根据手术入路分为开放组(n=48)与气膀胱腹腔镜组(气膀胱组,n=70),对比分析两组手术时间、切口长度、术后肉眼血尿时间、住院时间、肾输尿管积水恢复情况、术后并发症、再手术率等指标。结果:两组患儿年龄、体重、疾病类型、肾输尿管积水严重程度等差异均无统计学意义。与开放组相比,气膀胱组应用血制品少(P=0.001)、切口长度短(P<0.001)、黏膜下隧道与输尿管末端直径比大(P=0.001)、术后肉眼血尿时间短(P=0.005)、术后留置尿管时间短(P=0.023)、术后住院时间短(P<0.001),但手术时间长(P<0.001)。两组患儿术后肾输尿管积水情况均明显改善,气膀胱组较开放组肾盂积水改善更明显(P=0.035)。两组术后应用止疼药、住院期间泌尿系统感染发生率、术后反流与再梗阻、长期排尿异常及再次手术率差异无统计学意义。结论:治疗输尿管末端疾病,气膀胱腹腔镜Cohen手术相较传统开放手术具有美观、损伤小、术后康复快的优点,是安全、有效并值得推广的术式。Objective:To investigate the efficacy of pneumatic bladder laparoscopic Cohen procedure in the treatment of distal ureteral diseases.Methods:The clinical data of children with vesicoureteral reflux and ureteral end obstruction admitted from May 2011 to Dec.2021 were retrospectively analyzed.All patients underwent ureterovesical replantation and were divided into open group(n=48)and pneumatic bladder laparoscopic group(pneumatic bladder group,n=70)according to the surgical approach.The operation time,incision length,postoperative gross hematuria time,hospital stay,recovery of ureterohydronephrosis,postoperative complications and reoperation rate were compared and analyzed.Results:There was no significant difference in age,weight,disease type and severity of ureterohydronephrosis between the two groups.Compared with the open group,in the pneumatic bladder group,fewer blood products were used(P=0.001),the incision length was shorter(P<0.001),the diameter ratio of submucosal tunnel to the end of ureter was larger(P=0.001),the postoperative gross hematuria time was shorter(P=0.005),the postoperative indwelling catheter time was shorter(P=0.023),and the postoperative hospital stay was shorter(P<0.001),but the operation time was longer(P<0.001).Hydronephrosis and hydroureter were obviously improved in two groups,and the degree of hydronephrosis recovery in the pneumatic bladder group was more significant than that in open group(P=0.035).There was no significant difference in the use of postoperative analgesics,the incidence of urinary tract infection during hospitalization,postoperative reflux and re-obstruction,long-term paruria and reoperation between the two groups.Conclusions:Compared with the traditional open surgery,the pneumatic bladder laparoscopic Cohen operation has the advantages of cosmetic appearance,few injury and quick postoperative recovery in the treatment of ureteral end diseases,it is safe,effective and worthy of popularization.

关 键 词：输尿管疾病 输尿管再植 气膀胱腹腔镜检查 Cohen术 儿童 

分 类 号：R693[医药卫生—泌尿科学]