经尿道输尿管置入术和肾造瘘术在小婴儿重度肾积水治疗中的临床观察

Clinical observation of transurethral ureteral stent placement and nephrostomy in the treatment of severe hydronephrosis in infants

目的对比经尿道输尿管支架管置入术和肾造瘘术两种不同肾脏尿液引流方式用于缓解小婴儿重度肾积水的临床疗效。方法选取2014年12月至2018年5月间河北省儿童医院泌尿外科<3个月重度肾积水患儿40例,其中20例采用经尿道输尿管支架管置入术(S组),另外20例则采用肾造瘘术(N组),观察两组患儿术中情况及术后恢复效果。结果S组与N组术前积水程度,肾皮质厚度[(1.87±0.66)mm,(1.89±0.53)mm]以及术后6个月肾皮质厚度[(4.47±1.32)mm,(3.90±1.10)mm],组间差异均无统计学意义(P>0.05)。而两组平均手术时间、术中平均出血量、平均住院时间以及术后3个月时肾盂前后径,组间差异有统计学意义(P<0.05)。结论两种术式均可有效缓解尿路梗阻,可作为小婴儿重度肾积水Ⅰ期治疗的选择方案,其中经尿道输尿管支架管置入术手术操作简单、创伤小、耗时短,术后患儿恢复快,体表无创伤便于护理以及有概率免除后期离断成形手术可能,相较而言更有一定的临床应用价值。

Objective Transurethral ureteral stent placement and nephrostomy are two different methods of kidney urine drainage.This study aimed to compare the clinical effects of two different methods for the relief of severe hydronephrosis in infants.Methods Forty cases with severe hydronephrosis who were treated in Hebei Province Children′s Hospital from December 2014 to May 2018 were enrolled.Twenty cases were received transurethral ureteral stent placement(S group)and the other twenty cases were underwent nephrostomy(N group).The intraoperative conditions and postoperative recovery effects of the two groups were observed.Result The preoperative renal pelvis anteroposterior diameter,renal cortical thickness,and postoperative six months renal cortical thickness had no significant differences between two groups(P>0.05).The mean operation time,average intraoperative blood loss,average hospital stay,and anteroposterior diameter of the renal pelvis at 3 months after operation were significantly different between two groups(P<0.05).Conclusion Both procedures are effective and feasible treatment options for relieving urinary tract obstruction.They can be used as a primary treatment for stage I treatment of severe hydronephrosis in infants.Transurethral ureteral stent placement is easy to operate,has less trauma,takes less time,recovers quickly after surgery,has no trauma on the body surface,is easy to care for,and has a chance to avoid the possibility of postoperative amputation and shaping surgery.It has more clinical application value.