腹腔镜手术与传统开放手术治疗儿童重复肾畸形的对比研究

Comparison of efficacy between laparoscopy versus traditional open surgery for pediatric duplex kidney

目的对比分析腹腔镜重复肾切除术(laparoscopic upper pole heminephrectomy,LUHN)与开放重复肾切除术(open upper pole heminephrectomy,OUHN)治疗儿童重复肾畸形的疗效与安全性。方法本研究为回顾性研究,以重庆医科大学附属儿童医院泌尿外科2012年1月至2021年12月期间接受重复肾切除术的127例患儿为研究对象,按照不同手术方式分为腹腔镜手术组(n=87)和开放手术组(n=40)。比较两组患儿手术时间、术中出血量、住院时间、症状缓解率、输尿管囊肿缓解率、并发症发生率、再手术率等指标。结果腹腔镜手术组和开放手术组手术时间分别为130.0(100.0,170.0)min和75.0(61.3,85.0)min,出血量分别为(12.5±8.9)mL和(23.8±13.9)mL,术后住院时间分别为(6.3±1.5)d和(8.1±1.9)d,差异均有统计学意义(P<0.001);两组术后平均随访14个月,肾积水和尿失禁均消失,术后输尿管末端囊肿转归情况无统计学意义(P=0.741);术后尿路感染发生率(4.6%和12.5%)、肾切缘尿性囊肿的发生率(10.3%和20.0%)以及囊肿长径[(1.8±1.2)cm和(2.4±2.6)cm]差异均无统计学意义(P>0.05);两组再手术率分别为2.3%(2/87)和15.0%(6/40),差异有统计学意义(P=0.019),其中因输尿管残端综合征而再手术的比例为1.1%(1/87)和10.0%(4/40),差异有统计学意义(P=0.034);两组术后残肾萎缩发生率分别为0和7.5%(3/40),差异有统计学意义(P=0.030)。结论腹腔镜重复肾切除术可获得开放重复肾切除术同样的疗效,且手术更加微创,并发症更少,可作为治疗儿童重复肾的理想手术方式。

Objective To analysis and compare the efficacy of laparoscopy versus open upper pole heminephrectomy(OUHN)for duplex kidney.Methods A retrospective analysis was performed for 127 children undergoing upper pole heminephrectomy(UHN)from January 2012 to December 2021.They were assigned into two groups of laparoscopy(n=87)and open surgery(n=40).Operative duration,volume of blood loss,hospitalization stay,symptom relief rate,collapse of ureterocele,complication rate,reoperative rate and other parameters were compared between two surgical approaches.Results Operative duration for laparoscopy and open surgery groups was 130.0(100.0,170.0)and 75.0(61.3,85.0)min.Estimated volume of blood loss was(12.5±8.9)mL in laparoscopy group and(23.8±13.9)mL in open surgery group.Postoperative hospitalization stay was(6.3±1.5)days in laparoscopy group and(8.1±1.9)days in open surgery group.The differences in the above parameters were all statistically significant(P<0.001).During an average follow-up period of 14 months,both groups achieved a resolution of hydronephrosis and urinary incontinence.No statistically significant inter-group differences existed in the outcomes of ureterocele,postoperative urinary tract infection rate(4.6%vs.12.5%),incidence of renal parenchymal urine cysts(10.3%vs.20.0%)or cyst diameter(1.8±1.2 vs.2.4±2.6 cm)(P>0.05).Reoperative rate was 2.3%(2/87)in laparoscopy group and 15.0%(6/40)in open surgery group with a statistically significant difference(P=0.019).Reoperative rate for distal ureteral stump syndrome was 1.1%(1/87)in laparoscopy group and 10.0%(4/40)in open surgery group with a statistically significant difference(P=0.034).The incidence of postoperative renal atrophy was 0%in laparoscopy group and 7.5%(3/40)in open surgery group with a statistically significant difference(P=0.030).Conclusion Laparoscopic upper pole heminephrectomy(LUHN)has the same efficacy as OUHN.More mini-invasive with fewer complications,LUHN is an ideal option for duplex kidney in children.