腹腔镜与开放性离断式肾盂成形术治疗小儿肾盂输尿管连接部梗阻的比较

doi:10.3877/cma.j.issn.1674-3253.2023.06.012

目的

探讨腹腔镜与开放性离断式肾盂成形术（Anderson-Hynes术）两种术式治疗小儿肾盂输尿管连接部梗阻（UPJO）的临床疗效及优缺点。

方法

回顾性分析昆明医科大学第二附属医院77例UPJO患儿（<14周岁）的住院病例资料，其中腹腔镜Anderson-Hynes术（LP组）43例，开放性Anderson-Hynes术（OP组）34例。统计比较两组患者的一般资料、手术时间、术中出血量、肾周引流总量、术后抗菌药物使用率、术后止痛药物使用率、术后并发症发生率、近期肾积水缓解率、术后平均住院天数、住院费用、手术成功率。

结果

所有患儿手术均顺利完成，无中转其他方式及其他治疗者。两组患儿术前一般资料、术后抗菌药物使用情况、术后并发症发生率、近期肾积水缓解率、手术成功率差异均无统计学意义（P>0.05），LP组的术中出血量、肾周引流总量、术后平均住院天数、术后止痛药物使用率均低于OP组，而手术时间和住院费用高于OP组，差异有统计学意义（P<0.05）。

结论

腹腔镜Anderson-Hynes术治疗小儿UPJO安全、有效，与传统开放手术比较，腹腔镜手术创伤小、出血量少、术后恢复快、住院时间更短。随着腹腔镜手术的日益普及，腹腔镜Anderson-Hynes术值得作为小儿UPJO的推荐术式。

关键词: 肾盂输尿管连接部梗阻, 小儿, Andersen-Hynes术, 腹腔镜

Objective

To investigate the clinical efficacy, advantages and disadvantages of laparoscopic and open discontinuous pyeloplasty (Anderson-Hynes) in the treatment of pediatric ureteropelvic junction obstruction (UPJO).

Methods

The data of 77 UPJO children (<14 years old) in the Second Affiliated Hospital of Kunming Medical University was retrospectively analyzed, including 43 cases of laparoscopic Anderson-Hynes operation (LP group) and 34 cases of open Anderson-Hynes operation (OP group) ). The general information of the two groups, the length of operation, the amount of intraoperative blood loss, the total amount of perinephric drainage, postoperative antibacterial drug use rate, postoperative analgesic drug use rate, postoperative complications, recent hydronephrosis relief rate, and postoperative length of hospital stay, hospitalization expenses, and surgical success rate were compared.

Results

All the children's operations were successfully completed, and there was no conversion to other methods or other treatments. There were no statistically significant differences in the preoperative general data, postoperative antimicrobial drug use, postoperative complications, recent hydronephrosis relief rate, and surgical success rate between the two groups (P>0.05). In LP group, the intraoperative blood loss, the total amount of perinephric drainage, the average length of stay after surgery, and the use of postoperative pain medications were all lower than those of the OP group, while the length of operation and hospitalization costs were higher than those of the OP group, and the difference was statistically significant (P<0.05).

Conclusions

Laparoscopic Anderson-Hynes operation is safe and effective for the treatment of pediatric UPJO. Compared with traditional open surgery, laparoscopic surgery has less trauma, less blood loss, faster postoperative recovery, and shorter hospital stay. With the increasing popularity of laparoscopic surgery, laparoscopic Anderson-Hynes surgery is worthy of being the recommended procedure for pediatric UPJO.

Key words: UPJO, Children, Andersen-Hynes operation, Laparoscopy

图1 UPJO患者行腹腔镜离断式肾盂成形术过程注：a至e依次为UPJO患者肾盂输尿管连接部暴露、裁剪、缝合、置管、再缝合

表1 腹腔镜离断式肾盂成形术（LP组）与开放性离断式肾盂成形术（OP组）一般资料比较

组别	例数	年龄[岁，(±s)]	性别(例)		病变侧别(例)		就诊原因(例)				肾积水程度(例)
组别	例数	年龄[岁，(±s)]	男	女	左	右	体检	腰痛	尿路感染或血尿	腰部包块	轻度	中度	重度
LP组	43	7±3	35	8	33	10	29	8	4	2	3	25	15
OP组	34	6±4	29	5	26	8	23	7	3	1	4	19	11
统计值		t=-0.470	χ²=0.206		χ²=0.001		χ²=0.186				Z=-0.466
P值		0.640	0.650		0.978		0.980				0.461

表1 腹腔镜离断式肾盂成形术（LP组）与开放性离断式肾盂成形术（OP组）一般资料比较

组别	例数	年龄[岁，(±s)]	性别(例)		病变侧别(例)		就诊原因(例)				肾积水程度(例)
组别	例数	年龄[岁，(±s)]	男	女	左	右	体检	腰痛	尿路感染或血尿	腰部包块	轻度	中度	重度
LP组	43	7±3	35	8	33	10	29	8	4	2	3	25	15
OP组	34	6±4	29	5	26	8	23	7	3	1	4	19	11
统计值		t=-0.470	χ²=0.206		χ²=0.001		χ²=0.186				Z=-0.466
P值		0.640	0.650		0.978		0.980				0.461

表2 腹腔镜离断式肾盂成形术（LP组）与开放性离断式肾盂成形术（OP组）计量资料比较(±s)

组别	例数	手术时间(min)	术中出血量(ml)	肾周引流总量(ml)	住院天数(d)	住院费用(元)
LP组	43	191±39	17±80	071±39	6.6±1.9	22 136±5 464
OP组	34	161±40	39±19	115±56	9.2±3.1	14 455±3 742
统计值		t=-3.367	t=6.976	t=4.075	t=4.509	t=-6.998
P值		<0.001	<0.001	<0.001	<0.001	<0.001

表2 腹腔镜离断式肾盂成形术（LP组）与开放性离断式肾盂成形术（OP组）计量资料比较(±s)

组别	例数	手术时间(min)	术中出血量(ml)	肾周引流总量(ml)	住院天数(d)	住院费用(元)
LP组	43	191±39	17±80	071±39	6.6±1.9	22 136±5 464
OP组	34	161±40	39±19	115±56	9.2±3.1	14 455±3 742
统计值		t=-3.367	t=6.976	t=4.075	t=4.509	t=-6.998
P值		<0.001	<0.001	<0.001	<0.001	<0.001

表3 腹腔镜离断式肾盂成形术（LP组）与开放性离断式肾盂成形术（OP组）计数资料比较(例)

	例数	抗生素		止痛药		近期肾积水		手术
	例数	使用	未使用	使用	未使用	缓解	未缓解	成功	失败
LP组	43	19	24	18	25	29	14	40	3
OP组	34	22	12	28	6	22	12	32	2
统计值		χ²=3.211		χ²=12.944		χ²=0.064		χ²=0.037
P值		0.073		<0.001		0.801		0.847

表3 腹腔镜离断式肾盂成形术（LP组）与开放性离断式肾盂成形术（OP组）计数资料比较(例)

	例数	抗生素		止痛药		近期肾积水		手术
	例数	使用	未使用	使用	未使用	缓解	未缓解	成功	失败
LP组	43	19	24	18	25	29	14	40	3
OP组	34	22	12	28	6	22	12	32	2
统计值		χ²=3.211		χ²=12.944		χ²=0.064		χ²=0.037
P值		0.073		<0.001		0.801		0.847

表4 腹腔镜离断式肾盂成形术（LP组）与开放性离断式肾盂成形术（OP组）并发症发生情况比较(例)

	例数	术后感染	吻合口瘘	大网膜脱出	吻合口再狭窄	引流管脱出	输尿管支架脱出或回缩	无
LP组	43	7	6	7	3	1	2	17
OP组	34	9	3	2	2	2	0	16
统计值		χ²=5.359
P值		0.499

表4 腹腔镜离断式肾盂成形术（LP组）与开放性离断式肾盂成形术（OP组）并发症发生情况比较(例)

	例数	术后感染	吻合口瘘	大网膜脱出	吻合口再狭窄	引流管脱出	输尿管支架脱出或回缩	无
LP组	43	7	6	7	3	1	2	17
OP组	34	9	3	2	2	2	0	16
统计值		χ²=5.359
P值		0.499

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Comparison of laparoscopic and open disconnected pyeloplasty in the treatment of ureteropelvic junction obstruction in children

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Comparison of laparoscopic and open disconnected pyeloplasty in the treatment of ureteropelvic junction obstruction in children