腹腔镜下肾盂成形术治疗小儿肾积水的临床分析

Clinical Analysis of Laparoscopic Pyeloplasty in the Treatment of Hydronephrosis in Children

目的分析腹腔镜下肾盂成形术治疗小儿肾积水的临床效果。方法收集肾积水患儿79例的临床资料,根据治疗方式的不同将纳入患者分为对照组(n=38)和观察组(n=41),对照组患儿给予传统肾盂成形术治疗,观察组给予腹腔镜下肾盂成形术治疗,比较两组围术期指标情况、肾血流动力学指标、肌酐(Scr)、β2-微球蛋白(β2-MG)、α1-微球蛋白(α1-MG)水平,记录两组术后并发症发生情况。结果观察组手术时间、进食时间、住院时间短于对照组,术中出血量少于对照组(P均<0.05)。两组术后1 d血流收缩期峰值流速(PS)、平均速度(TAMx)、舒张期峰值速度(ED)、最低速度(TAMn)均升高,且观察组高于对照组(P均<0.05)。两组术后1 dβ2-MG、α1-MG均降低,且观察组低于对照组(P均<0.05)。两组术前、术后1 d以及组间阻力指数(RI)、Scr比较差异均无统计学意义(P均>0.05)。两组术后并发症发生率比较差异无统计学意义(P>0.05)。结论腹腔镜下肾盂成形术治疗小儿肾积水,可有效改善肾血流动力学及血清β2-MG、α1-MG水平,具有一定的临床应用价值。

Objective To analyze the clinical effect of laparoscopic pyeloplasty in the treatment of hydronephrosis in children.Methods The clinical data of 79 children with hydronephrosis were selected.According to the different treatment methods,the patients were divided into control group(n=38)and observation group(n=41).The control group was treated with traditional pyeloplasty and the observation group was treated with laparoscopic pyeloplasty.The perioperative indexes,renal hemodynamics indexes,creatinine(Scr),β2-microglobulin(β2-MG)andα1-microglobulin(α1-MG)levels were compared between the two groups,and the incidence of postoperative complications were recorded.Results The operation time,eating time and hospitalization time of the observation group were shorter than those of the control group,and the intraoperative blood loss was less than that of the control group(P all<0.05).The peak systolic velocity(PS),mean velocity(TAMx),peak diastolic velocity(ED)and minimum velocity(TAMn)of blood flow in the two groups increased 1 day after operation,and the observation group was higher than the control group(P all<0.05).β2-MG andα1-MG in the two groups decreased 1 day after operation,and the observation group was lower than the control group(P all<0.05).There was no significant difference in resistance index(RI)and Scr between the two groups before and 1 day after operation(P all>0.05).There was no difference in the incidence of postoperative complications between the two groups(P>0.05).Conclusion Laparoscopic pyeloplasty for hydronephrosis in children can effectively improve renal hemodynamics indexes and serum levels ofβ2-MG、α1-MG.It has certain clinical application value.