小儿腹腔镜肾盂成形术343例临床分析及手术探讨

The experience of laparoscopic pyeloplasty in children-a report of 343 cases

目的：总结343例腹腔镜肾盂成形术临床经验，探讨腹腔镜肾盂成形术的治疗效果。方法2008年1月至2014年12月作者实施腹腔镜肾盂成形术治疗儿童肾盂输尿管连接部梗阻（ureteropel-vic junction obstruction，UPJO）343例（为 LP 组），收集其年龄、侧别、病变程度、手术时间、出血量、术后并发症、住院时间等临床资料。并与前期及同期开放手术治疗的191例（为开放组）进行比较，判定手术效果、总结手术技巧及经验。结果接受腹腔镜肾盂成形术治疗的343例患儿无中转开放手术病例，LP 组手术时间与开放组相当（P ＞0．05），但 LP 组前20例手术时间长于开放组（P ＜0．05）；LP 组手术失血量少于开放组（P ＜0．05），术后住院日短于开放组（P ＜0．05）。结论腹腔镜肾盂成形术是一种安全有效的治疗方式，其远期疗效与开放手术无明显差别，且同样适用于小于3月龄的重度肾积水患儿。

Objetive To evaluate the experience and result of laparoscopic pyeloplasty（LP）in children with ureteropelvic junction obstruction（UPJO）.Methods A retrospective analysis was made on the 343 chil-dren with hydronephrosis who underwent laparoscopic pyeloplasty（LP）in our hospital from Jan.2008 to Dec. 2014.Clinical data was collected,including age,side,size of the lesion,time of operation,blood loss,hospi-talization time and complication,and compared to that of open pyeloplasty（OP）.The experience and result were evalued. Results LP in all cases were successful.The mean operation time was similar to OP（P〉0.05）,while the blood loss and hospitalization time after operation were less than OP（P 〈0.05）.However, the operation time of first 20 cases of LP was longer than OP（P 〈0.05）. Conclusions Laparoscopic pyelo-plasty was a safe and effective way to cure chidren with UPJO and could also be applied to serious children un-der 3 months old,while there was no difference of long-term effect compared to open pyeloplasty.