经膀胱镜置入输尿管支架管治疗小于3个月婴儿重度肾积水

Placement of ureteral stent for severe hydronephrosis in infants aged under 3 months

目的对单纯通过经膀胱镜置入输尿管支架管治疗<3个月婴儿的原发性肾积水的疗效和其相应的并发症进行研究,评价其临床疗效。方法收集河北省儿童医院泌尿外科自2014年12月至2018年5月收治的<3个月重度肾积水患儿20例。其中,男19例,女1例;年龄为(1.95±0.56)个月;患侧为左侧14例,右侧6例。所有患儿均接受经膀胱镜输尿管支架置入术一期治疗重度肾积水,于术前、输尿管支架管置入后及取出后对患儿进行B型超声检查,并对临床表现进行观察,记录相应的治疗结果和手术并发症。结果所有患儿中有2例置管失败(左、右侧各1例),予更换为肾造瘘术以缓解肾积水,另外18例均顺利置入输尿管支架管,术中操作时间短,为(15.22±5.75)min,出血量极微,为(0.50±0.42)ml,术后观察到的并发症主要表现有泌尿系统感染、血尿和支架管的梗阻。患儿住院天数为(4.72±1.81)d,治疗前肾盂前后径及肾皮质厚度分别为(34.28±7.00)mm和(1.86±0.66)mm,置管后6个月变化为(11.00±4.56)mm和(4.47±1.32)mm,可观察到肾积水程度的明显缓解和肾皮质的增厚。而在取出输尿管支架管后,有8例患儿的肾积水无再次加重表现,观察至今无特殊处理。结论经膀胱镜输尿管支架管置入术是一种微创术式,可作为临床治疗小婴儿(<3个月)重度肾积水的一种选择方法,术后可明确缓解肾积水程度,并且在取出支架管后存在治愈此年龄段原发性肾积水的可能,使患儿免受于较大手术创伤,值得进一步临床应用研究。

Objective To evaluate the clinical efficacy and its corresponding complications of transurethral stenting for primary hydronephrosis in infants aged under 3 months.Methods Retrospective analysis was performed for 20 children aged under 3 months with severe hydronephrosis hospitalized at Children's Hospital of Hebei Province from December 2014 to May 2018. There were 19 boys and 1 girl. The involved side was left (n=14) and right (n=6). Ureteral stenting was employed for relieving severe hydronephrosis. Ultrasonic examinations were performed before and after stenting and after removal .The clinical manifestations were observed and the corresponding treatment outcomes and surgical complications recorded.Results Two patients had failed placement, after which nephrostomy was performed for relieving hydronephrosis. Stenting was successful in other 18 children. The intraoperative duration was (15.22±5.75) min and the amount of bleeding minimal was(0.50±0.42)ml. The major postoperative complications included urinary tract infection, hematuria and tube obstruction. The average hospital stay was (4.72±1.81) days. Before treatment, diameter of anterioposterior renal pelvis and thickness of renal cortex (34.28±7.00) and (1.86±0.66) mm respectively. The changes were (11.00±4.56) and (4.47±1.32) mm after 6-month stenting. Marked relief of renal hydronephrosis and thickening of renal cortex were observed. After removing stent, 8 cases of hydronephrosis were not further aggravated and observations continued without any special measure.Conclusions Transurethral stenting is an ideal mini-invasive procedure for severe hydronephrosis in infants aged under 3 months. Postoperatively it may definitely relieve the degree of hydronephrosis. And after removing stent, there is a high chance of curing primary hydronephrosis in this age period. Thus it is necessary to protect these children from major surgical trauma. Further clinical application researches are required.