Lich⁃Gregoir和Cohen两种经腹腔镜术式治疗儿童输尿管膀胱连接部畸形的效果和安全性比较  

Clinical efficacy and safety of laparoscopic Lich⁃Regoir and Cohen techniques in the treatment of ureterobladder junction malformation in children

作　　者：邱杰 喻正波 陈玉烛 施晓欣 罗震 庄利恺 顾胜利 QIU Jie;YU Zhengbo;CHEN Yuzhu;SHI Xiaoxin;LUO Zheng;ZHUANG Likai;GU Shengli(Pediatric Surgery Department,Zunyi First People′s Hospital,Zunyi Medical University,Zunyi 563000,China;不详)

机构地区：[1]遵义市第一人民医院(遵义医科大学第三附属医院)小儿外科,贵州遵义563000 [2]遵义医科大学附属医院泌尿外科,贵州遵义563000 [3]遵义医科大学附属医院小儿泌尿外科,贵州遵义563000 [4]复旦大学附属儿科医院泌尿外科,上海201102

出　　处：《实用医学杂志》2023年第12期1541-1545,共5页The Journal of Practical Medicine

基　　金：贵州省卫生健康委科学技术基金项目(编号:gzwkj2021⁃291)。

摘　　要：目的比较经腹腔镜Lich⁃Gregoir术式和经气膀胱腹腔镜Cohen术式治疗儿童输尿管膀胱连接部畸形的临床效果和安全性。方法回顾性分析医院小儿外科2018年2月至2022年9月收治的70例儿童输尿管膀胱连接部畸形患儿,根据术式差异,分为两组。A组35例,采用经腹腔镜Lich⁃Gregoir术式治疗;B组35例,采用经气膀胱腹腔镜Cohen术式治疗。比较两组患儿手术指标、治疗效果、并发症、氧化应激[超氧化物歧化酶(SOD)、丙二醛(MDA)、皮质醇(Cor)和肾上腺素(E)]和炎性因子[肿瘤坏死因子⁃α(TNF⁃α)、白细胞介素⁃8(IL⁃8)和IL⁃10]水平差异。结果B组患儿住院时间显著少于A组(P<0.05);两组术后3个月排尿性膀胱尿道造影(VCUG)复查结果提示所有患儿肾积水程度均减轻,无反流;两组术后并发症发生率比较差异无统计学意义(2.86%vs.5.72%,P>0.05);两组患儿术毕时血清SOD活性显著降低,MDA、Cor、E、TNF⁃α、IL⁃8和IL⁃10水平显著增加(P<0.05),两组间比较差异无统计学意义(P>0.05)。结论经腹腔镜Lich⁃Gregoir术式和经气膀胱腹腔镜Cohen术式治疗儿童输尿管膀胱连接部畸形的疗效和安全性相当,对患儿应激和炎性程度影响接近,临床医生应根据实际情况择优选择。Objective To compare the clinical effect and safety of laparoscopic Lich⁃Gregoir and laparo⁃scopic Cohen techniques in the treatment of children′s uretero⁃bladder junction malformation.Methods The clinical data of 70 children with ureterovesical conjunctival malformation admitted to the pediatric surgery department of our hospital from February 2018 to September 2022 were retrospectively reviewed and analyzed.The patients treated by laparoscopic Lich⁃Gregoir approach were assigned to group A(n=35)and those treated by laparoscopic Cohen approach to group B(n=35).The two groups were compared in terms of surgical indexes,therapeutic effects,complications,oxidative stress including levels of superoxide dismutase(SOD),malondialdehyde(MDA),cortisol(Cor)and epinephrine(E),and inflammatory factors including tumor necrosis factor⁃α(TNF⁃α),interleukin⁃8(IL⁃8)and IL⁃10.Results The average hospital stay in group B was significantly shorter than that in group A(P<0.05).The reexamination results of urinary cystourethrography(VCUG)3 months after operation in both groups indicated that hydronephrosis was relieved and no reflux was observed in all the children.There was no significant difference in the incidence of postoperative complications between the two groups(2.86%vs.5.72%,P>0.05).After surgery,the serum SOD activity was significantly decreased,and the levels of MDA,Cor,E,TNF⁃α,IL⁃8 and IL⁃10 were significantly increased in both groups(P<0.05),but there was no significant difference between the two groups(P>0.05).Conclusion Laparoscopic Lich⁃Regoir technique and laparoscopic Cohen technique have the same efficacy and safety in the treatment of children′s uretero⁃bladder junction malformation,and have a similar impact on the stress and inflammation in them.Surgeons should optimize their surgical approaches according to the conditions of diseased children and their own proficiency in the surgical operation.

关 键 词：输尿管膀胱连接部畸形 儿童 Lich⁃Gregoir术 Cohen术 

分 类 号：R726.9[医药卫生—儿科]