儿童单侧UPJO腹腔镜下肾盂输尿管成形术后吻合口暂时性梗阻的危险因素分析

The risk factors of transient anastomotic obstruction after laparoscopic pyeloplasty for unilateral UPJO in children

目的探讨腹腔镜肾盂输尿管成形术后发生吻合口暂时性梗阻的危险因素。方法收集本院泌尿外科2007年7月至2015年6月实施腹腔镜肾盂输尿管成形术患儿的临床资料,共360例。按照是否发生吻合口暂时性梗阻分为两组,比较两组术后发生吻合口暂时性梗阻与年龄、体重、性别、术侧、术前积水程度、有无息肉、病变段输尿管长度及引流方式的相关性。结果 360例中,术后发生吻合口暂时性梗阻24例(占6.7%),两组在年龄、引流方式上比较,差异有统计学意义(P<0.05)。多因素分析表明,年龄>72个月、肾造瘘管外引流以及输尿管支架管外引流可增加吻合口暂时性梗阻的发生率,是术后发生吻合口暂时性梗阻的独立危险因素。结论年龄与外引流是术后吻合口暂时性梗阻的危险因素。术中应避免肾盂内血凝块存留,适当延长外引流时间,以减少或避免因水肿所致吻合口暂时性梗阻的发生风险。

Objetive To analyze the risk factors of transient anastomotic obstruction after laparoscopic pyeloplasty. Methods We retrospectively analyzed 360 children who underwent laparoscopic pyeloplasty from July 2007 to June 2015. Measures included preoperative factors and postoperative complications. Age at operation, weight, gender, laterality, preoperative degree of hydronephrosis, polyp, segment of stenosis, and chose of drainage were analyzed. Results During hospitalizati0n,transient anastomotic obstruction occurred in 24 children （3.6%）. Difference in age and drainage was statistical significance （P 〈 0. 05 ）. Multivariate analysis revealed older than 72month, nephrostomy tube and ureterie stent as the independent risk factors for transient anastomotie obstruction after laparoscopic dismembered pyeloplasty. It can increase the probability of this complication. Conclusions age and external stent as the independent risk factors for transient anastomotic obstruction after laparoscopic pyeloplasty. We should avoid leaving blood clot in pelvis intraopratively and extend the period of removal for external stent,to lower the risk of transient anastomotic obstruction postoperatively.