气膀胱下Politano-Leadbetter术治疗小儿膀胱输尿管连接部异常的临床疗效分析  

Clinical efficacy of gas-bladder laparoscopic Politano-Leadbetter for congenital malformation of vesicoureteral junction in children

作　　者：吴永隆 陈海琛 胡杨[1] 徐延波 徐波[1] WU Yonglong;CHEN Haichen;HU Yang;XU Yanbo;XU Bo(Department of Pediatric Surgery,Women and Children's Hospital,School of Medicine,Xiamen University,Xiamen,Fujian,361003,China)

机构地区：[1]厦门大学附属妇女儿童医院(厦门市妇幼保健院)小儿外科,福建厦门361003

出　　处：《临床泌尿外科杂志》2023年第3期179-183,共5页Journal of Clinical Urology

摘　　要：目的:比较气膀胱下Politano-Leadbetter与Cohen输尿管再植术治疗小儿膀胱输尿管连接部异常的临床疗效。方法:回顾性分析我院2016年1月—2020年3月收治的51例膀胱输尿管连接部异常的患儿,早期24例行Cohen术式,后期27例采用Politano-Leadbetter术,术后随访6个月~3年,比较2组手术时长、术中出血量、术后住院时间、并发症及术后输尿管扩张恢复情况。结果:51例患儿均在气膀胱下顺利完成手术,无一例中转开腹,2组手术时间[(114.42±29.84)min vs(129.59±47.42)min,P=0.18]、术中出血量[(5.88±4.81)mL vs(5.81±4.25)mL,P=0.96]、术后住院时间[(10.17±2.65)d vs(10.56±3.23)d,P=0.64]比较差异无统计学意义;所有患儿拔除尿管后排尿通畅,无尿漏。2组患儿各有2例术后出现尿路感染1次,2组并发症发生率差异无统计学意义(P=0.32)。术后1、3、6个月定期复查泌尿系超声,2组患儿术后输尿管扩张情况均较术前好转,48例完全恢复,3例部分恢复;其中Cohen组2例,Politano-Leadbetter组1例,术前均为巨输尿管,术后6个月复查排尿性膀胱泌尿道造影(VCUG)均未见反流,2组输尿管恢复情况差异无统计学意义(P=0.59)。结论:气膀胱下Politano-Leadbetter术治疗小儿膀胱输尿管连接部异常的临床疗效确切、安全有效,具有微创优势的特点;同时Politano-Leadbetter术的输尿管符合自然生理解剖特点,在输尿管游离范围、裁剪及黏膜下隧道长度方面具有Cohen术所不具备的优势,值得临床推广。Objective:To compare the clinical efficacy between laparoscopic Politano-Leadbetter and Cohen ureteric reimplantation for congenital malformation of vesicoureteral junction in children.Methods:A retrospective analysis of 51 patients who underwent ureteric reimplantation from January 2016 to March 2020 was conducted.The first 24 cases were given Cohen procedure,while the remaining 27 cases underwent Politano-Leadbetter procedure.The follow-up period was 6 months to 3 years.Comparisons in terms of operative duration,blood loss,hospital stay,complication rate and postoperative ureteral dilatation were made.Results:All 51 cases underwent ureteric reimplantation successfully,and none of them were transferred to open surgery.No significant differences were found in operation time([114.42±29.84]min vs[129.59±47.42]min,P=0.18),blood loss([5.88±4.81]mL vs[5.81±4.25]mL,P=0.96),hospital stay([10.17±2.65]d vs[10.56±3.23]d,P=0.64)between the groups.All children had no obstructed urination or urinary leakage after removing the catheter.There was no significant difference in the incidence of complications between the two groups(P=0.32).After 1 month,3 months,6 months,ureteral dilatation of 48 cases recovered completely and 3 cases partially recovered.Among the two groups,there was no significant difference in ureteral recovery(P=0.59).Conclusion:The procedure of Politano-Leadbetter is an effective and safe option for congenital malformation of vesicoureteral junction in children.The operation has the characteristics of minimally invasive advantages.Compared with Cohen,Politano-Leadbetter is easier to operate in terms of natural physiological anatomy,so it is worthy of clinical promotion.

关 键 词：膀胱输尿管畸形 腹腔镜手术 输尿管再植 

分 类 号：R693[医药卫生—泌尿科学]