儿童肾盂成形术后再梗阻的临床特点和诊治经验  

Failed pyveloplasty in children:our experience and cdlinical characteristics

作　　者：梁海燕[1] 李佳义 何雨竹 李怡 杨艳芳[2] 孙宁[1] 张潍平[1] Liang Haiyan;Li Jiayi;He Yuzhu;Li Yi;Yang Yanfang;Sun Ning;Zhang Weiping(Department of Urology,Beijing Children's Hospital of Capital Medical University,Beijingg100045,China;Department of Urology,Henan Children's Hospital,Zhengzhou Children's Hospital,Zhengzhou 450018,China)

机构地区：[1]国家儿童医学中心,首都医科大学附属北京儿童医院泌尿外科,北京100045 [2]郑州大学附属儿童医院,河南省儿童医院,郑州儿童医院泌尿外科,郑州450018

出　　处：《中华泌尿外科杂志》2023年第6期440-445,共6页Chinese Journal of Urology

摘　　要：目的总结儿童肾盂成形术后再梗阻患者的临床特点和诊治经验。方法回顾性分析2015年1月至2022年4月北京儿童医院收治的因初次肾盂成形术后再梗阻行再次手术的54例患儿的临床资料。男47例(87.03%),女7例(12.96%)。中位年龄51.67(21.30,117.24)个月。梗阻位于左侧38例(70.37%),右侧16例(29.63%)。初次手术为开放式肾盂成形术(POP)20例(37.03%),腹腔镜肾盂成形术(PLP)34例(62.96%)。初次手术于我院完成45例(83.33%),外院完成9例(16.67%)。再次手术与初次手术时间间隔7.25(6.15,15.40)个月。再次手术前有临床症状28例(51.85%),其中表现为反复腹痛、恶心、呕吐21例,反复发热、泌尿系感染7例;无症状仅影像学检查提示再梗阻26例(48.15%)。术前肾盂前后径(APD)5.45(5.13,5.77)cm;APD/肾实质厚度(PT)21.71(21.08,35.77)。54例均确诊梗阻后再次行肾盂成形术,术式分别为再次腹腔镜肾盂成形术(RLP)和再次开放肾盂成形术(ROP)。RLP组11例,男8例(72.72%),女3例(27.28%);中位年龄82.21(49.83,114.05)个月;梗阻位于左侧8例(72.72%),右侧3例(27.28%);初次手术为POP3例(27.28%),PLP8例(72.72%);再次手术距初次手术时间12.83(6.34,16.86)个月;术前APD5.18(4.25,6.14)cm。ROP组43例,男38例(88.37%),女5例(12.63%);中位年龄52.32(26.62,77.35)个月;梗阻位于左侧31例(72.09%),右侧12例(27.91%);初次手术为POP19例(44.19%),PLP24例(55.81%);再次手术距初次手术时间10.02(8.03,15.51)个月;术前APD5.42(5.14,5.90)cm。再次手术中发现梗阻原因为:吻合口瘢痕增生性狭窄28例(51.85%),残留异位血管压迫7例(12.96%),高位输尿管吻合口8例(14.81%),输尿管粘连扭曲7例(12.96%),其他4例(7.41%)(医用胶硬壳压迫1例,管腔息肉样增生1例,管腔完全闭塞2例)。比较RLP组和ROP组的手术时间、术后并发症,以及术后3、6个月的APD、APD改善率(PI-APD)、PT、APD/PT。结果本研究54例均获得随访,平均随访时间(34.41±20.20)个月。再次肾盂Objective To summarize the clinical characteristics,diagnosis and treatment experience of children with reobstruction after pyeloplasty.Methods A retrospective analysis was conducted on patients admitted to the Department of Urology,Beijing Childrens Hospital from January 2015 to April 2022.Due to the unrelieved hydronephroplasty after the primary pyeloplasty,the anterior and posterior diameter of the pelvis was larger than that before the primary operation.Intravenous pyelography and diuretic renal radionuclide scanning confirmed the diagnosis of ureteropelvic reobstruction.Or underwent reoperation after undergoing puncture angiography for reobstruction.Fifty-four children were included in the study,47 males(87.03%)and 7 females(12.96%),with a median age of 51.67(21.30,117.24)month,and,38 cases(70.37%)on the left side and 16 cases(29.63%)on the right side.The primary operation was open pyeloplasty(POP)in 20 cases and laparoscopic pyeloplasty(PLP)in 34 cases.45 patients underwent primary operation in our hospital,and 9 patients were referred from other hospitals after primary operation.The interval between reoperation and initial operation was 7.25(6.15,15.40)month.There were 28 cases with clinical symptoms before operation,and 26 cases without symptoms but reobstruction on imaging.21 cases presented with recurrent abdominal pain,nausea and vomiting,and 7 cases presented with recurrent fever and urinary tract infection.All 54 patients underwent re-pyeloplasty after definite diagnosis of reobstruction.In order to further study the feasibility of RLP,patients in the two groups were divided into RLP and ROP groups according to different surgical procedures.In the RLP group,there were 8 males(72.72D before operation was 5.18(4.25,6.14)cm.There were 43 cases in the ROP group,including 38 males(88.37%)and 5 females(12.63%).The median age was 52.32(26.62,77.35)months;Obstruction was located on the left side in 31 cases(72.09%)and the right side in 12 cases(27.91%).The primary operation was performed in 19 cases(44.19%)w

关 键 词：儿童 肾盂输尿管连接处梗阻 肾盂成形术 腹腔镜肾盂成形术 开放肾盂成形术 

分 类 号：R726.9[医药卫生—儿科]