气膀胱Cohen术与腹腔镜膀胱外输尿管再植术治疗输尿管末端梗阻的疗效比较

Comparison of clinical efficacy between gas-bladder laparoscopic Cohen procedure versus laparoscopic extravesical ureterovesical replantation for malformation of vesicoureteral junction

目的评价气膀胱Cohen术与腹腔镜膀胱外输尿管再植术治疗小儿膀胱输尿管连接部梗阻的临床效果。方法收集2014年2月至2019年8月本院收治的31例单侧先天性膀胱输尿管连接部梗阻患儿资料,按手术方式分为腹腔镜气膀胱Cohen再植组(17例)和腹腔镜膀胱外输尿管再植组(14例)。比较两组手术时间、术后静脉使用抗生素时间、术后血尿时间、留置尿管时间、术后住院时间及住院费用。结果气膀胱Cohen再植组与腹腔镜下膀胱外再植组手术时间分别为(194±46)min、(152±52)min,术后住院时间分别为(8.1±1.1)d、(6.4±1.2)d,术后血尿时间分别为(3.2±0.7)d、(1.5±1.1)d,差异均具有统计学意义。术后抗生素使用时间分别为(5.6±1.1)d、(5.2±1.2)d,留置尿管时间分别为(6.3±1.3)d、(5.5±1.2)d,住院总费用分别为(23357.2±4638.5)元、(21194±3518.2)元,差异均不具有统计学意义。两组均无中转开放手术,随访3~12个月,获访病例临床症状均缓解,术后气膀胱Cohen再植组获随访13例,复查超声提示10例输尿管恢复正常,输尿管积水消失,1例发生术后尿路感染,1例输尿管轻度扩张,2例有输尿管Ⅱ°反流。腹腔镜膀胱外再植组获随访11例,复查超声提示10侧输尿管恢复正常,输尿管积水消失;1例输尿管轻度扩张,未见输尿管反流。结论两种手术方式治疗小儿膀胱输尿管连接部梗阻临床疗效均确切,腹腔镜膀胱外输尿管再植术较气膀胱腹腔镜输尿管再植术术中用时少、膀胱创伤小、术后恢复更快,为安全有效的手术方式。

Objective To compare the efficacy of gas-bladder laparoscopic Cohen procedure versus laparoscopic extravesical ureterovesical replantation for malformation of vesicoureteral junction in children.Methods From February 2014 to August 2019,gas-bladder laparoscopic Cohen procedure(n=17)and laparoscopic extravesical ureterovesical replantation under submucosal tunnel(n=14)were performed for unilateral malformation of vesicoureteral junction.Detailed clinical data were reviewed,including operative duration,postoperative time of intravenous antibiotic,postoperative hematuria time,length of urethral catheterization,postoperative hospitalization and hospital expenditure.A comparative study of major clinical parameters was performed.Results The mean operative duration of both groups was(194±46)and(152±52)min,the mean hospitalization stay was(8.1±1.1)and(6.4±1.2)days and the mean postoperative hematuria time was(3.2±0.7)and(1.5±1.1)days respectively.All of the above parameters had significant differences.The postoperative antibiotic dosing time was(5.6±1.1)and(5.2±1.2)days,the average time of indwelling catheter was(6.3±1.3)and(5.5±1.2)days and the mean hospital expenditure was(23357.2±4638.5)and(21194±3518.2)yuan respectively.No statistical differences existed in the above parameters.There was no conversion into open surgery in either groups.After a follow-up period of 3-12 months,the preoperative symptoms disappeared.For 13 cases in gas-bladder laparoscopic Cohen group,ultrasound showed that hydronephrosis disappeared and ureter normalized(n=10).The outcomes were postoperative urinary tract infection(n=1),mild ureteral dilation(n=1)and ureteral reflux II(n=1);For 11 cases in laparoscopic extravesical ureterovesical replantation group,ultrasound showed that hydronephrosis disappeared and ureter normalized(n=10).There was mild ureteral dilation(n=1)without ureteral reflux.Conclusions Clinical efficacies of both procedures are definite for obstruction of vesicoureteral junction in children.As compared with gas-bladder laparoscopic Cohen procedure,laparoscopic extravesical ureterovesical replantation is less time-consuming and more mini-invasive and recovers faster.