腹腔镜非离断式Lich-Gregoir输尿管再植术治疗小儿原发性膀胱输尿管反流  

Efficacy of laparoscopic nondismembered Lich-Gregoir ureteral reimplantation for primary vesicoureteral reflux in children

作　　者：傅淑琪 张谦[1] 李骥[1] 王磊[1] 郭立华[1] 孙权[1] 崔展阁 Fu Shuqi;Zhang Qian;Li Ji;Wang Lei;Guo Lihua;Sun Quan;Cui Zhange(Department of Pediatric Surgery,First Affiliated Hospital,Zhengzhou University,Zhengzhou 450052,China)

机构地区：[1]郑州大学第一附属医院小儿外科,郑州450052

出　　处：《中华小儿外科杂志》2024年第5期425-430,共6页Chinese Journal of Pediatric Surgery

摘　　要：目的探索腹腔镜非离断式Lich-Gregoir输尿管再植术在治疗小儿原发性膀胱输尿管反流的特点与优势。方法回顾性分析2018年10月至2022年10月郑州大学第一附属医院小儿外科收治的31例原发性膀胱输尿管反流患儿的临床资料,根据手术方式分为腹腔镜非离断式Lich-Gregoir输尿管再植术组(A组)17例和气膀胱经腹腔镜Cohen输尿管再植术组(B组)14例,两组患儿根据患侧数再分为单侧组(A1、B1组)和双侧组(A2、B2组),比较患儿手术前、后泌尿系彩色多普勒超声肾盂前后径参数变化,采用配对样本t检验进行统计学分析;比较两组中患儿手术时间、术中出血量、术后留置导尿管天数,记录术后泌尿道感染、术后反流、术后吻合口梗阻等并发症发生情况。结果所有患儿均顺利完成手术,无一例中转开放手术。A1组手术时长为(150.8±12.6)min,B1组手术时长为(178.0±24.9)min;A2组手术时长为(238.8±9.4)min,B2组手术时长为(248.4±9.2)min。A组手术时长均小于B组,差异具有统计学意义(P<0.05);将A、B组左右侧膀胱输尿管反流患儿手术前后肾盂前后径值分别进行配对样本t检验,差异具有统计学意义(P<0.05);术中出血量、术后血尿天数等数值进行统计学分析,差异均不具有统计学意义(P>0.05)。随访6~36个月,获访病例临床症状均缓解,无一例出现高级别反流等并发症。结论腹腔镜非离断式Lich-Gregoir输尿管再植术治疗原发性膀胱输尿管反流疗效确切,相较于气膀胱经腹腔镜Cohen输尿管再植术手术时间更短,对膀胱的损害更小,术后并发症少。ObjectiveTo evaluate the characteristics and advantages of laparoscopic nondismembered Lich-Gregoir ureteral replantation for primary vesicoureteral reflux in children.MethodsFrom October 2018 to October 2022,the relevant clinical data were retrospectively reviewed for 31 hospitalized children of primary vesicoureteral reflux(VUR).According to operative approaches,they were assigned into two groups of laparoscopic nondismembered Lich-Gregoir ureteral reimplantation(A,n=17)and gas-bladder Cohen ureteral reimplantation(B,n=14).Based upon the number of affected sides,they were further divided into two groups of unilateral(A1/B1)and bilateral(A2/B2).The parameters of anteroposterior diameter(APD)of renal pelvis were compared before and after surgery and paired sample t-test was employed for statistical processing.Operative duration,intraoperative volume of blood loss and duration of postoperative urinary catheterization were compared.The incidence of such complications as postoperative urinary tract infection,postoperative reflux and postoperative anastomotic obstruction was recorded.ResultsAll operations were successfully completed without any conversion into open surgery.Operative duration was(150.8±12.6)min in A1 group,(178.0±24.9)min in B1 group,(238.8±9.4)min in A2 group and(248.4±9.2)min in B2 group.Average operative duration of group A was less than that of group B and the difference was statistically significant(P<0.05).APD of renal pelvis values of children with left/right VUR in groups A and B were tested for paired samples before and after surgery and the differences were statistically significant(P<0.05).Intraoperative volume of blood loss,postoperative duration of hematuria and other values were statistically analyzed and the differences were not statistically significant(P>0.05).During a follow-up period of(6-36)months,all clinical symptoms were relieved and there was no onset of high-grade reflux.ConclusionLaparoscopic ureteral replantation is efficacious for primary VUR in children.As compared wit

关 键 词：腹腔镜 原发性膀胱输尿管反流 输尿管再植术 儿童 

分 类 号：R726.9[医药卫生—儿科]