经结肠系膜途径和经结肠旁沟途径腹腔镜肾盂成形术治疗儿童UPJO的对比研究

A comparative study of transcolonic and paracolic laparoscopic pyeloplasty in children with UPJO

目的:比较经结肠系膜途径和经结肠旁沟途径腹腔镜肾盂成形术治疗儿童肾盂输尿管连接部梗阻(UPJO)导致的单纯性肾积水的优劣,并分析影响手术效果的可能因素。方法:回顾性分析2020年1月至2023年1月河北医科大学第二医院泌尿外科收治并实施腹腔镜肾盂成形术的71例UPJO患儿的临床资料,年龄0.25~18(7.70±4.82)岁,其中经结肠系膜途径30例(系膜组),经结肠旁沟途径41例(旁沟组),比较两组患儿的一般资料、手术时间、术中出血量、引流管留置时间、术后进食时间、住院总费用、手术效果、术后并发症发生情况及家属手术满意度等。结果:手术均一次性完成,过程顺利无中转开腹,两组患儿一般资料比较差异无统计学意义(P>0.05),具有可比性。两组在手术时间、术中出血量、术后进食时间、术后引流管留置时间、住院总费用、手术效果、手术满意度等差异无统计学意义(P>0.05)。系膜组5例患儿、旁沟组4例患儿出现术后发热、腹痛等常见并发症,均在药物治疗或无干预下缓解,无二次手术或致死性并发症发生。本研究未发现年龄、BMI、术前症状有无、肾积水严重程度及ABO血型分类等对手术效果存在影响。结论:经结肠系膜入路和经结肠旁沟入路腹腔镜肾盂成形术均可有效治疗由UPJO引起的儿童单纯性肾积水,两种手术方式在手术时间、术中出血量、术后进食时间、引流管留置时间、手术效果、手术满意度及术后并发症等方面无统计学差异,同时年龄、BMI、术前症状有无、肾积水严重程度及ABO血型分类等对手术效果无显著影响。

Objective:Comparing the laparoscopic pyeloplasty via the mesocolon and para-colonic gutter approach for the treatment of pediatric pelvi-ureteric junction obstruction(UPJO)induced simple hydronephrosis,and analyzing the potential factors influencing surgical outcomes.Methods:Clinical data of 71 children with UPJO who underwent laparoscopic pyeloplasty at the Department of Urology of the Second Hospital of Hebei Medical University from January 2020 to January 2023 were analyzed.The patients,aged 0.25 to 18 years,were divided into two groups:30 cases underwent the transcolonic route(mesangial group)and 41 cases underwent the transcolonic paragutter route(paragrow group).Results:showed that both surgical approaches had similar outcomes in terms of operation completion,smooth process,absence of laparotomy,operation time,intraoperative blood loss,postoperative feeding time,and postoperative drainage tube indwelling time,total hospitalization cost,surgical effect,and satisfaction.Common complications such as postoperative fever and abdominal pain were managed with drug treatment or observation,with no need for secondary surgery or fatal complications.Factors such as age,body mass index,preoperative symptoms,severity of hydronephrosis,and ABO blood group classification did not impact the surgical outcome.Conclusions:There was no statistically significant difference between laparoscopic py-eloplasty and another surgical method in terms of various surgical outcomes for children with ureteropelvic junction obstruction.Factors such as age,body mass index,preoperative symptoms,severity of hydronephrosis,and ABO blood group classification did not have a significant impact on the surgical outcome.