腹腔镜小儿肾盂成形术中不同手术入路选择的临床研究  

Clinical study on different surgical approaches to laparoscopic pyeloplasty in children

作　　者：唐亚斯 禹伸频 叶春伟 李志鹏 TANG Yasi;YU Shenpin;YE Chunwei;LI Zhipeng(First Affiliated Hospital of Kunming Medical University,Kunming 650032,China;不详)

机构地区：[1]昆明医科大学第一附属医院,昆明650032 [2]昆明医科大学第三附属医院 [3]昆明医科大学第二附属医院

出　　处：《现代泌尿生殖肿瘤杂志》2024年第2期81-84,共4页Journal of Contemporary Urologic and Reproductive Oncology

摘　　要：目的比较经腹腔入路和经腹膜后入路行腹腔镜小儿肾盂成形术的临床疗效。方法收集2018年1月至2022年12月14岁及以下行腹腔镜肾盂成形术的123例患儿,其中经腹腔入路58例,经腹膜后入路65例,比较两组的术中、术后指标以及术后并发症。结果经腹腔入路组的年龄小于经腹膜后入路组(P<0.05),经腹膜后入路组的胃肠道功能恢复时间、引流管留置时间和术后住院时间短于经腹腔入路组(P<0.05),经腹膜后入路组的术后并发症少于经腹腔入路组(P<0.05)。两组的手术时间、术中失血量和输尿管支架拔除时间差异无统计学意义(P>0.05)。结论年龄较大的患儿可选择经腹膜后入路,低位肾盂输尿管连接处梗阻、年龄小的小儿,尤其婴幼儿,推荐经腹腔入路,两种入路均有各自优势,应根据患儿发育、年龄和解剖结构特点来选择手术入路,可以降低手术难度,减少并发症,提高手术精细度和成功率。Objective To compare the clinical effect of laparoscopic pyeloplasty in children through transperitoneal approach and retroperitoneal approach.Methods From January 2018 to December 2022,123 children aged 14 years and younger who underwent laparoscopic pyeloplasty were collected,including 58 with a transperitoneal approach and 65 with a retroperitoneal approach.The intraoperative and postoperative indices as well as postoperative complications were compared between the two groups.Results The age of the transperitoneal access group was younger than that of the retroperitoneal access group(P<0.05).The time to recovery of gastrointestinal function,time to drainage tube retention and postoperative hospital stay were shorter in the retroperitoneal access group than in the transperitoneal access group(P<0.05),and the postoperative complications were less in the retroperitoneal access group than in the transperitoneal access group(P<0.05).The differences in operative time,intraoperative blood loss or D-J tube removal time between the two groups were not statistically significant(P>0.05).Conclusions A retroperitoneal approach can be chosen for older children,and a transabdominal approach is recommended for low ureteropelvic junction obstruction and younger children,especially infants.Both approaches have their own advantages,so the surgical approach should be selected according to the developmental,age and anatomical characteristics of the child.Then,the difficulty of surgery and complications can be reduced,and surgical refinement and success rate can be improved.

关 键 词：小儿腹腔镜 肾盂输尿管连接处梗阻 肾盂成形术 手术入路 

分 类 号：R726.9[医药卫生—儿科]