腹腔镜离断式肾盂输尿管成形术治疗肾盂输尿管连接部梗阻肾积水患儿临床效果及BUN、SCr与GFR水平变化分析

Clinical Effect of Laparoscopic Disconnected Pyeloplasty in the Treatment of Ureteropelvic Junction Obstruction in Children with Hydronephrosis and Changes of BUN,Scr and GFR Levels

目的分析腹腔镜离断式肾盂输尿管成形术治疗肾盂输尿管连接部梗阻(UPJO)肾积水患儿的临床效果及尿素(BUN)、血肌酐(SCr)、肾小球滤过率(GFR)水平变化。方法回顾性分析2018年2月-2021年5月收治的127例UPJO肾积水患儿临床资料,根据手术方式不同分为研究组68例(予腹腔镜离断式肾盂输尿管成形术治疗)和对照组59例(予开放离断式肾盂成形术治疗)。比较2组临床疗效,治疗前后肾功能指标(BUN、SCr、GFR),手术相关指标(手术时间、术中出血量、术后住院时间、术后镇痛剂用量)及术后并发症发生情况。结果研究组临床总有效率高于对照组(P<0.05)。治疗后2组SCr、BUN均下降,而GFR均上升,其中以研究组变化更为明显(P<0.05,P<0.01)。研究组手术时间长于对照组,术中出血量及术后镇痛剂用量均少于对照组,术后住院时间短于对照组(P<0.05,P<0.01)。研究组术后并发症发生率低于对照组(P<0.05)。结论腹腔镜离断式肾盂输尿管成形术治疗UPJO肾积水患儿效果确切,可有效缩短患儿恢复时间、改善肾功能。

Objective To analyze the clinical effect of laparoscopic disconnected pyeloplasty in the treatment of ureteropelvic junction obstruction(UPJO)in children with hydronephrosis and changes of blood urea nitrogen(BUN),serum creatinine(SCr),and glomerular filtration rate(GFR)levels.Methods The clinical data of 127 children with hydronephrosis caused by UPJO who were treated from February 2018 to May 2021 were retrospectively analyzed.According to different surgical methods,they were divided into the research group(treated by laparoscopic disconnected pyeloplasty,n=68)and the control group(treated by open and disconnected pyeloplasty,n=59).The clinical efficacy,renal function indexes(BUN,SCr,GFR)before and after treatment,operation-related indexes(duration of operation,intraoperative blood loss,postoperative hospital stay,postoperative analgesic dosage)and postoperative complications were compared between the two groups.Results The total effective rate in the research group was higher than that in the control group(P<0.05).After treatment,SCr and BUN in both groups decreased,while GFR increased,and the changes were more significant in the research group(P<0.05,P<0.01).The duration of operation was longer in the research group than in the control group,intraoperative blood loss and postoperative analgesic dosage were less than those of the control group,and the postoperative hospital stay was shorter than that of the control group,and(P<0.05,P<0.01).The incidence of postoperative complications in the research group was lower than that in the control group(P<0.05).Conclusion Laparoscopic disconnected pyeloplasty is effective in the treatment of children with hydronephrosis caused by UPJO,which can effectively shorten the recovery time and improve renal function.