Efficacy of secondary laparoscopic pyeloplasty in the treatment of ureteropelvic junction obstruction

doi:10.3877/cma.j.issn.1674-3253.2023.03.006

Abstract

Abstract:

Objective

To analyze the safety and efficacy of secondary laparoscopic pyeloplasty.

Methods

From January 2018 to June 2022, the clinical data of 10 children in our hospital who underwent secondary laparoscopic pyeloplasty and 59 children who underwent primary laparoscopic pyeloplasty were collected. The baseline data, intraoperative, postoperative and follow-up data of the two groups were statistically analyzed, and the main clinical indicators were compared and analyzed. Postoperative complications were graded using the Clavien-Dindo criteria. Surgical success was defined as clinical symptom relief and no worsening of hydrops at postoperative follow-up.

Results

There was no significant difference in sex, age, body weight, affected kidney and clinical manifestation between the two groups (P>0.05). In the intraoperative and postoperative data, the median hospital stay for reoperation and the median postoperative hospital stay were longer in the secondary LP group (P<0.001). The total incidence of complications in the secondary LP group was higher (P=0.006), mainly Clavien-Dindo grade I complications. However, the surgical success rate was similar between the two groups (P=0.907).

Conclusions

The grade of complications after secondary laparoscopic pyeloplasty is low, and the surgical success rate is similar to that of primary laparoscopic pyeloplasty. It is a safe and effective surgical approach for the failure of primary laparoscopic pyeloplasty.

Key words: UPJ, Laparoscopy, Pyeloplasty, Secondary surgery, ERAS

Huajian Lai, Wenwen Zhong, Qiang Guo, Juntao Li, Yifei Zhang, Lei Ye, Bo Ma, Bing Yao, Hu Qu, Jianguang Qiu, Dejuan Wang. Efficacy of secondary laparoscopic pyeloplasty in the treatment of ureteropelvic junction obstruction[J]. Chinese Journal of Endourology(Electronic Edition), 2023, 17(03): 228-232.

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URL: https://zhqjmnmwkzz.cma-cmc.com.cn/EN/10.3877/cma.j.issn.1674-3253.2023.03.006

https://zhqjmnmwkzz.cma-cmc.com.cn/EN/Y2023/V17/I03/228

Figures/Tables 3

References 17

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序号	性别	距离初次手术时间(个月)	症状	术前超声APD(mm)	术前SFU分级	患侧	手术方式	二次术前的干预	手术时间(min)	症状缓解	术后超声APD(mm)	术后SFU分级	随访时间(个月)
1	F	6.0	泌尿系感染、呕吐	27	3	L	腹腔镜	双J管	210	是	20	3	5.2
2	M	6.0	泌尿系感染	96	4	L	腹腔镜	球囊扩张术+双J管	220	是	35	3	12.8
3	M	10.0	-	23	3	L	腹腔镜	肾造瘘+双J管	257	否	9	3	13.6
4	F	25.9	腰痛	37	4	L	腹腔镜	-	223	是	15	3	12.5
5	M	8.4	-	52	3	R	腹腔镜+肾造瘘	内镜下狭窄切开+双J管	349	否	27	2	1.8
6	M	72.0	腰痛	11	4	L	腹腔镜+肾造瘘	肾造瘘	360	是	9	4	7.4
7	F	5.2	腰腹痛、恶心、呕吐	32	3	L	腹腔镜中转开腹	球囊扩张+双J管	529	是	25	2	2.3
8	M	24.0	泌尿系感染	58	4	R	腹腔镜+肾造瘘+膀胱造瘘	球囊扩张+双J管+肾造瘘	518	是	31	4	3.0
9	M	28.9	-	10	2	L	腹腔镜	肾造瘘	240	否	5	2	0.3
10	F	6.0	腹痛	118	3	R	腹腔镜	双J管	252	是	8	1	10.4

序号	性别	距离初次手术时间(个月)	症状	术前超声APD(mm)	术前SFU分级	患侧	手术方式	二次术前的干预	手术时间(min)	症状缓解	术后超声APD(mm)	术后SFU分级	随访时间(个月)
1	F	6.0	泌尿系感染、呕吐	27	3	L	腹腔镜	双J管	210	是	20	3	5.2
2	M	6.0	泌尿系感染	96	4	L	腹腔镜	球囊扩张术+双J管	220	是	35	3	12.8
3	M	10.0	-	23	3	L	腹腔镜	肾造瘘+双J管	257	否	9	3	13.6
4	F	25.9	腰痛	37	4	L	腹腔镜	-	223	是	15	3	12.5
5	M	8.4	-	52	3	R	腹腔镜+肾造瘘	内镜下狭窄切开+双J管	349	否	27	2	1.8
6	M	72.0	腰痛	11	4	L	腹腔镜+肾造瘘	肾造瘘	360	是	9	4	7.4
7	F	5.2	腰腹痛、恶心、呕吐	32	3	L	腹腔镜中转开腹	球囊扩张+双J管	529	是	25	2	2.3
8	M	24.0	泌尿系感染	58	4	R	腹腔镜+肾造瘘+膀胱造瘘	球囊扩张+双J管+肾造瘘	518	是	31	4	3.0
9	M	28.9	-	10	2	L	腹腔镜	肾造瘘	240	否	5	2	0.3
10	F	6.0	腹痛	118	3	R	腹腔镜	双J管	252	是	8	1	10.4

组别	例数	性别（例）		年龄[月，M(Q)]（男例）	体质量[kg，M(Q)]	受累侧（例）		术前症状（例）
组别	例数	男	女	年龄[月，M(Q)]（男例）	体质量[kg，M(Q)]	左	右	有	无
初次LP组	59	41	18	60(5，204)	26(12，60)	41	18	25	34
二次LP组	10	6	4	168(23.6，420)	51.1(14.5，58.5)	7	3	7	3
统计值		χ²=0.052		Z=-1.756	Z=-0.281	χ²=0		χ²=1.631
P值		0.819		0.079	0.778	1		0.202

组别	例数	性别（例）		年龄[月，M(Q)]（男例）	体质量[kg，M(Q)]	受累侧（例）		术前症状（例）
组别	例数	男	女	年龄[月，M(Q)]（男例）	体质量[kg，M(Q)]	左	右	有	无
初次LP组	59	41	18	60(5，204)	26(12，60)	41	18	25	34
二次LP组	10	6	4	168(23.6，420)	51.1(14.5，58.5)	7	3	7	3
统计值		χ²=0.052		Z=-1.756	Z=-0.281	χ²=0		χ²=1.631
P值		0.819		0.079	0.778	1		0.202

组别	例数	手术时间[min，M(Q)]	术中出血量[ml，M(Q)]	术中转开腹手术(例)	住院时间[d，M(Q)]	术后住院时间[d，M(Q)]	总并发症(例)	Ⅰ	Ⅱ	Ⅲ	手术成功(例)	再住院(例)
初次LP组	59	258(226，300)	10(5，20)	0	6.9(4.1，8.9)	2.6(1.5，3.8)	9	3	2	5	55	3
二次LP组	10	254.5(222，399）	20(20，50)	1	16.8(14.1，20.7)	5.8(3.8，10.9)	6	3	1	2	10	1
统计值		Z=-0.724	Z=-2.719	-	Z=-4.585	Z=-3.716	χ²=7.605	-	-	χ²=0.302	-	-
P值		0.469	0.007	0.145	<0.001	<0.001	0.006	0.036	0.380	0.582	1	0.474

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