腹腔镜与开放性离断式肾盂成形术治疗小儿肾盂输尿管连接部梗阻的比较

Comparison of laparoscopic and open disconnected pyeloplasty in the treatment of ureteropelvic junction obstruction in children

目的探讨腹腔镜与开放性离断式肾盂成形术(Anderson-Hynes术)两种术式治疗小儿肾盂输尿管连接部梗阻(UPJO)的临床疗效及优缺点。方法回顾性分析昆明医科大学第二附属医院77例UPJO患儿(<14周岁)的住院病例资料,其中腹腔镜Anderson-Hynes术(LP组)43例,开放性Anderson-Hynes术(OP组)34例。统计比较两组患者的一般资料、手术时间、术中出血量、肾周引流总量、术后抗菌药物使用率、术后止痛药物使用率、术后并发症发生率、近期肾积水缓解率、术后平均住院天数、住院费用、手术成功率。结果所有患儿手术均顺利完成,无中转其他方式及其他治疗者。两组患儿术前一般资料、术后抗菌药物使用情况、术后并发症发生率、近期肾积水缓解率、手术成功率差异均无统计学意义(P>0.05),LP组的术中出血量、肾周引流总量、术后平均住院天数、术后止痛药物使用率均低于OP组,而手术时间和住院费用高于OP组,差异有统计学意义(P<0.05)。结论腹腔镜Anderson-Hynes术治疗小儿UPJO安全、有效,与传统开放手术比较,腹腔镜手术创伤小、出血量少、术后恢复快、住院时间更短。随着腹腔镜手术的日益普及,腹腔镜Anderson-Hynes术值得作为小儿UPJO的推荐术式。

Objective To investigate the clinical efficacy, advantages and disadvantages of laparoscopic and open discontinuous pyeloplasty (Anderson-Hynes) in the treatment of pediatric ureteropelvic junction obstruction (UPJO).MethodsThe data of 77 UPJO children (<14 years old) in the Second Affiliated Hospital of Kunming Medical University was retrospectively analyzed, including 43 cases of laparoscopic Anderson-Hynes operation (LP group) and 34 cases of open Anderson-Hynes operation (OP group). The general information of the two groups, the length of operation, the amount of intraoperative blood loss, the total amount of perinephric drainage, postoperative antibacterial drug use rate, postoperative analgesic drug use rate, postoperative complications, recent hydronephrosis relief rate, and postoperative length of hospital stay, hospitalization expenses, and surgical success rate were compared.ResultsAll the children's operations were successfully completed, and there was no conversion to other methods or other treatments. There were no statistically significant differences in the preoperative general data, postoperative antimicrobial drug use, postoperative complications, recent hydronephrosis relief rate, and surgical success rate between the two groups (P>0.05). In LP group, the intraoperative blood loss, the total amount of perinephric drainage, the average length of stay after surgery, and the use of postoperative pain medications were all lower than those of the OP group, while the length of operation and hospitalization costs were higher than those of the OP group, and the difference was statistically significant (P<0.05).ConclusionsLaparoscopic Anderson-Hynes operation is safe and effective for the treatment of pediatric UPJO. Compared with traditional open surgery, laparoscopic surgery has less trauma, less blood loss, faster postoperative recovery, and shorter hospital stay. With the increasing popularity of laparoscopic surgery, laparoscopic Anderson-Hynes surgery is worthy of being the recommended procedure for pediatric UPJO.