肾造瘘后Ⅱ期与Ⅰ期肾盂成形术治疗小婴儿重度肾积水的效果比较

Comparison of clinical efficacy between one-stage pyeloplasty and second-stage pyeloplasty after nephrostomy for the treatment of severe hydronephrosis in infants

目的·探讨分期肾盂成形术(先期肾造瘘)与不分期肾盂成形术治疗小于3个月重度肾积水患儿的临床效果。方法·回顾性分析上海交通大学医学院附属新华医院2012年1月—2015年7月接受手术治疗的小于3个月重度肾积水患儿的临床资料。25例行分期肾盂成形术(A组),39例行不分期肾盂成形术(B组)。比较2组手术时间、术中出血量、并发症发生率、总住院时间及术后肾积水恢复情况等。结果·共有64例小于3个月重度肾积水患儿纳入研究。A组手术时间、总住院时间、术后尿路感染发生率明显高于B组,分别为(81±20)min与(53±18)min、(11.6±2.6)d与(6.2±1.5)d、36.0%与17.9%。术后6个月,2组患儿肾积水程度和肾脏功能均得到显著改善,组间差异无统计学意义。结论·分期肾盂成形术对于小于3月龄重度积水患儿肾脏的最终形态、功能恢复没有明显优势;不分期肾盂成形术安全、有效,应作为小婴儿重度肾积水的首选治疗方式。

Objective · To investigate the clinical efficacy of one-stage pyeloplasty and second-stage pyeloplasty after nephrostomy for the treatment of severe hydronephrosis in infants younger than 3 months. Methods · Clinical data of severe hydronephrosis infants younger than 3 months who underwent pyeloplasty at Xinhua Hospital affiliated to the Shanghai Jiao Tong University School of Medicine from Jan. 2012 to Jul. 2015 were retrospectively analyzed. Twenty-five patients received second-stage pyeloplasty after nephrostomy （the A group） and 39 patients received one-stage pyeloplasty （the B group）. The operative time, intraoperative blood loss, incidence rate of complications, hospital stay, and postoperative recovery were compared between two groups. Results · Sixty-four severe hydronephrosis infants younger than 3 months were enrolled. The A group has longer operative time and hospital stay and higher incidence rate of postoperative urinary tract infection as compared with the B group [（81 ± 20） min vs （53 ± 18） min, （11.6 ± 2.6） dvs （6.2 ± 1.5） d, and 36.0% vs 17.9%）, respectively]. The hydronephrosis and renal function in two groups were significantly improved 6 months after surgery and the difference between two groups was not statistically significant. Conclusion · Second-stage pyeloplasty after nephrostomy has no obvious advantage for the treatment of severe hydronephrosis in infants younger than 3 months with respect to the final morphology and function recovery of involved kidneys. One-stage pyeloplasty is safe and effective and should be served as the preferred method for the treatment of severe hydronephrosis in infants.