腹腔镜下肾盂成形术治疗小儿肾盂输尿管连接部梗阻所致巨大肾积水及术后引流方式的研究

摘要

Objective To explore the feasibility of laparoscopic Anderson-Hynes pyeloplasty for pediatric giant hydronephrosis (GH) caused by ureteropelvic junction obstruction (UPJO). Methods From April 2008 to May 2015, a total of 83 GH patients (84 kidneys) caused by UPJO who underwent laparoscopic Anderson-Hynes pyeloplasty performed by a single surgeon team were retrospectively analyzed .Postoperatively , the relief of hydronephrosis was evaluated with anterior-posterior diameter of dilated pelvicaliceal system with continuous B-ultrasonography .All the patients were divided into either internal drainage or external drainage group .The operative time , complications , length of hospitalization , and the ratio of hydronephrosis remission were evaluated between the two different pattern of drainage . Results All the operations were successfully completed laparoscopically .No conversion to open surgery was required .The patients were followed up for 3-24 months (mean, 16 months).At the 3, 6, 12, and 24 postoperative months , there were 33 and 47 cases, 30 and 44 cases, 27 and 32 cases, and 12 and 16 cases followed in the external and internal drainage groups , respectively .Postoperatively , the hydronephrosis was relieved in all the cases , without significant difference between the two groups ( P>0.05).There was no statistical difference in the operative time between the external and internal drainage groups [(161.9 ±23.8) min vs.(164.0 ±24.7) min, t=-0.388, P=0.699].No pneumoperitoneum related complications or gastrointestinal injuries occurred .Postoperative complications were found in 18 cases (21.7%, 18/83), 14 of which (16.9%, 14/83 ) were Clavien-Grade Ⅰ complications and the rest of the 4 cases ( 4.8%, 4/83 ) were Clavien-Grade Ⅱ complications.There was no significant difference in postoperative complications between the two groups [14.3%(5/35) vs.27.1%(13/48),χ2 =2.408, P=0.661].There was significant difference in length of hospitalization between the external and internal drainage groups [(9.8 ±1.3) d vs.(7.8 ±1.2) d, t =7.239, P =0.000]. Conclusions Laparoscopic Anderson-Hynes pyeloplasty for GH is safe and effective .Both external and internal drainage have satisfactory results .%目的 评估腹腔镜下Anderson-Hynes肾盂成形术治疗小儿肾盂输尿管连接部梗阻(ureteropelvic junction obstruction,UPJO)所致巨大肾积水的可行性,探讨术后肾盂尿液引流方式的选择.方法 2008年4月~2015年5月采用经腹腔入路腹腔镜下Anderson-Hynes肾盂成形术治疗83例UPJO所致巨大肾积水,术后连续B超检测肾集合系统扩张分离的前后径(anterior-posterior,AP),评价术后肾积水缓解情况.术后采用内引流和外引流2种肾盂尿液引流方式,按引流方式分为2组,比较2组手术时间、并发症、术后住院时间.结果 83例均在腹腔镜下顺利完成Anderson-Hynes肾盂输尿管成形术,无中转开放手术.术后随访3~24个月,平均16个月,术后3、6、12、24个月外引流组和内引流组分别随访33、47例,30、44例,27、32例,12、16例,术后肾积水均缓解,2组均无统计学差异(P>0.05),无再手术.外引流组和内引流组手术时间无统计学差异[(161.9±23.8)min vs.(164.0±24.7)min,t=-0.388,P=0.699].术中均未发生与气腹有关的并发症,无肠道及脏器损伤.术后2组出现并发症18例(21.7%,18/83),其中14例(16.9%,14/83)为ClavienⅠ级,4例(4.8%,4/83)为ClavienⅡ级,2组术后并发症发生率无明显差异[14.3%(5/35)vs.27.1%(13/48),χ2=2.408,P=0.661].外引流组和内引流组术后住院时间有显著性差异[(9.8±1.3)d vs.(7.8±1.2)d,t=7.239,P=0.000].结论 腹腔镜下Anderson-Hynes肾盂成形术治疗UPJO引起的小儿巨大肾积水是安全、有效的可选择方式,2种引流方式的疗效均良好.