腹腔镜下肾盂成形术治疗小于3个月重度肾积水患儿效果分析

Analysis on the effect of laparoscopic pyeloplasty for children aged less than 3 months with severe hydronephrosis

目的:分析腹腔镜下肾盂成形术治疗小于3个月重度肾积水患儿的效果。方法:选择2015年3月—2016年12月在本院诊治的50例小于3个月重度肾积水患儿为研究对象,采用腹腔镜下肾盂成形术治疗。观察患儿的治疗效果。结果:50例手术均成功,没有一例需要中转开放手术,也没有其他并发症的发生。术后对所有患儿进行随访。随访中发现7例泌尿系感染,但是抗感染治疗后症状消失,双J管拔除后,无该症状出现。术后3个月伤口瘢痕不明显。术后6个月核素肾图复查表明所有患儿吻合口通畅,出现不同程度的肾皮质增厚。未发生吻合口狭窄。术后肾盂前后径[(1.3±0.6)cm]较术前[(4.2±0.8)cm]明显减小,术后肾小球滤过率[(74.4±5.4)ml·min-1·1.73 m-2]较术前[(55.2+6.0)ml·min-1·1.73 m-2]明显增加,差异均具有统计学意义(P<0.05)。结论:腹腔镜下肾盂成形术治疗小于3个月重度肾积水患儿,疗效确切、安全,外观好。

Objective： To analyze the therapeutic effect of laparoscopic pyeloplasty for children aged less than 3 months with severe hydronephrosis. Methods： Fifty children aged less than 3 months with severe hydronephrosis, admitted to the Zhengzhou Children＇s Hospital from Mar. 2015 to Dec. 2016, received laparoscopic pyeloplasty. The therapeutic effect was observed. Results： Fifty cases of laparoscopic pyeloplasty were all successful with no complications and no need of transferring to open surgery. All the children were followed up after operation, urinary tract infection were found in 7 cases during the follow-up period, while the symptoms disappeared after anti-infection treatment, and no symptoms occurred after extraction of the double J tube. The wound scar was not obvious 3 months after the operation. It was showed by reexamination of nuclide kidney diagram 6 months after operation that the anastomosis in all the children was unobstructed and thickening of renal cortex appeared in varying degrees. No anastomotic stenosis occurred. The anterior and posterior diameter of renal pelvis decreased after treatment [（1.3±0.6）cm] than before treatment [（4.2±0.8）cm], and the filtration rate of glomerular increased after treatment [（74.4±5.4）ml·min-1·1.73 m-2] than before treatment [（55.2＋6.0）ml·min-1·1.73 m-2] with significant differences （P〈0.05）. Conclusions： Laparoscopic pyeloplasty shows a definite curative effect with safety and good outward appearance for children aged less than 3 months with severe hydronephrosis.