腹腔镜输尿管端侧吻合术与输尿管膀胱再植术治疗儿童完全性肾输尿管重复畸形的疗效比较  

Comparison of efficacy between laparoscopic ureteroureterostomy and ureteral reimplantation for the treatment of complete renal and ureteral duplication in children

作　　者：于彬 李泸平[1] 范应中[1] Yu Bin;Li Luping;Fan Yingzhong(Department of Pediatric Surgery,the First Affiliated Hospital of 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：《中华实用儿科临床杂志》2025年第1期33-38,共6页Chinese Journal of Applied Clinical Pediatrics

摘　　要：目的探讨腹腔镜输尿管端侧吻合术(LUU)与输尿管膀胱再植术(UR)在儿童完全性肾输尿管重复畸形治疗中的应用价值。方法回顾性病例系列研究。将2016年1月至2022年12月郑州大学第一附属医院术前经泌尿系彩超、利尿肾图和CT尿路造影或磁共振尿路造影、排尿性膀胱尿路造影等影像学检查确诊为完全性肾输尿管重复畸形且资料完整的65例患儿纳入研究,按照手术方式不同分为LUU组(35例)和UR组(30例)。比较2组患儿手术时长、术中出血量、置入支架管例数、术后住院天数、手术前后患侧上位肾盂前后径(APD)变化、上位输尿管管径(UD)变化、患侧分肾功能(DRF)变化等情况。对于手术时间、术中出血量等符合正态分布的连续变量,采用±s表示,组间差异通过独立样本t检验、组内差异通过配对t检验分析。对于不符合正态分布的连续变量,使用M(Q 1,Q 3)描述,组间差异通过秩和检验比较。性别、侧别等为分类变量,使用χ^(2)检验比较2组率的差异。结果LUU、UR组术中出血量[(8.5±4.6)mL比(12.6±6.4)mL]比较差异有统计学意义(t=2.465,P=0.020),2组术后住院天数[(6.4±2.3)d比(10.5±2.8)d]比较差异有统计学意义(t=2.308,P=0.027);LUU、UR组手术时间[(143.0±13.2)min比(132.0±12.4)min]比较差异无统计学意义(t=-1.965,P=0.057);2组置入输尿管支架管例数[(35/35)例比(26/30)例]比较差异无统计学意义(χ^(2)=2.932,P=0.087)。UR组出现远期并发症4例(吻合口狭窄2例、膀胱输尿管反流1例、反复尿路感染1例),LUU组出现远期并发症1例(吻合口狭窄1例),差异无统计学意义(χ^(2)=1.239,P=0.266)。2组术前术后上位肾APD、UD、患侧DRF均有显著改善,上位APD改善值(t=-0.032,P=0.962)、DRF改善值(Z=1.895,P=0.073)及UD改善值(t=1.832,P=0.079)差异均无统计学意义。结论LUU和UR治疗儿童完全性肾输尿管重复畸形均安全、有效。相较于UR,LUU术中出血量及术后住院�ObjectiveTo compare the therapeutic value between laparoscopic ureteroureterostomy(LUU)and ureteral reimplantation(UR)for the treatment of pediatric complete renal and ureteral duplication.MethodsThis retrospective case-series study included 65 children with complete data,who were diagnosed with complete renal and ureteral duplication at the First Affiliated Hospital of Zhengzhou University from January 2016 to December 2022.Diagnoses were confirmed through preoperative imaging tests,including renal ultrasound,diuretic renography,computed tomography urography,magnetic resonance urography,and voiding cystourethrography.The patients were categorized into 2 groups based on surgical approach.The LUU group had 35 patients,and the UR group had 30 patients.The surgical duration,intraoperative blood loss,the incidence of stent implantation,postoperative length of hospitalization,the upper renal anterioposterior diameter(APD),the upper ureter diameter(UD),and differential renal function(DRF)of the affected kidney before and after surgery were compared between the 2 groups.For continuous variables such as surgery time and intraoperative blood loss that follow a normal distribution,values are expressed as Mean±SD,with between-group differences analyzed using independent t-tests and within-group differences using paired t-tests.For non-normally distributed continuous variables,data are presented as M(Q 1,Q 3),with group differences assessed by rank-sum tests.Categorical variables like gender and laterality are compared using Chi-square tests.ResultsIntraoperative blood loss was significantly different between the LUU and UR groups[(8.5±4.6)mL vs.(12.6±6.4)mL](t=2.465,P=0.020).Postoperative length of hospitalization also differed significantly between the 2 groups[(6.4±2.3)days vs.(10.5±2.8)days](t=2.308,P=0.027).However,surgical durations of the groups were similar[(143.0±13.2)min vs.(132.0±12.4)min](t=-1.965,P=0.057).No significant difference was observed between the two groups[(35/35)cases vs.(26/30)cases](χ^(2)=2.

关 键 词：儿童 输尿管端侧吻合 输尿管膀胱再植 腹腔镜 重复肾 

分 类 号：R726.9[医药卫生—儿科]