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

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

Abstract

Abstract:

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

Tao Ma, Chunwei Ye, Tao Liu, Wenxi Peng, Zhipeng Li. Comparison of laparoscopic and open disconnected pyeloplasty in the treatment of ureteropelvic junction obstruction in children[J]. Chinese Journal of Endourology(Electronic Edition), 2023, 17(06): 605-610.

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Figures/Tables 5

References 33

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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

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

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

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

	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

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