后腹腔镜手术与开放手术治疗小儿先天性重度肾积水的临床疗效对比

摘要

目的：比较后腹腔镜与传统开放手术治疗小儿先天性重度肾积水的临床疗效和安全性。方法：选取47例由先天性肾盂输尿管连接部梗阻引起的重度肾积水的患儿，根据手术方式的不同将其分为观察组(21例)与对照组(26例)。观察组采用后腹腔镜手术治疗，对照组采用传统开放手术治疗，比较两组患儿平均手术时间、平均出血量、住院时间、疼痛模拟评分以及术后感染率等。结果：两组患儿均成功完成离断式肾盂成形术，无严重并发症发生。观察组在平均出血量、平均住院时间及疼痛评分等方面均优于对照组，两组比较有差异(t=5.518，t=18.296， t=11.666；P＜0.05)；观察组平均手术时间短于对照组，两组比较有差异(t=10.855，P＜0.05)；两组术后感染率相比无差异，术后随访6个月，两组患儿均未见复发。结论：经后腹腔镜下离断式肾盂成形术治疗由先天性肾盂输尿管连接部梗阻引起的小儿重度肾积水安全有效，具有创伤小、术后恢复快以及美容效果好等优点，可替代传统开放手术。%Objective:To compare the effectiveness and potential advantages and complications between retroperitoneoscopic pyeloplasty and classical open pyeloplasty in children with congenital serious hydronephrosis.Methods:47 cases who were confirmed ureteropelvic junction obstruction (UPJO) in children with congenital serious hydronephrosis were selected and divided into the observation group with 21 cases and the control group with 26 cases. Two patient cohorts with undergoing open or retroperitoneoscopic pyeloplasty were analysed comparatively.Results: The patients in two groups completed Anderson-Hynes operation successfully without serious complications. When the therapeutic outcomes of the two groups were compared, the average blood loss, mean hospital stay, analogue scale of pain and the infection rate in the observation group were better than that in the control group (t=5.518,t=18.296,t=11.666;P<0.05). But the average operation time in the observation group was longer than the control group (t=10.855,P<0.05). No recurrence was found in these two groups following-up 6 months.Conclusion: Retroperitoneoscopic pyeloplasty is a safe and effective procedure for the treatment of UPJO in the children with congenital serious hydronephrosis. It has some advantages of less trauma, improved cosmetic effect and postoperative quicker recovery, which can replace classical open pyeloplasty.