腹腔镜与开放性离断式肾盂成形术治疗肾盂输尿管连接部梗阻患者的效果

Effect of Laparoscopic and Open Dismembered Pyeloplasty in the Treatment of Patients with Ureteropelvic Junction Obstruction

目的:比较腹腔镜与开放性离断式肾盂成形术治疗肾盂输尿管连接部梗阻(UPJO)患者的效果。方法:选择2020年10月—2022年4月于泉州市妇幼保健院·儿童医院小儿泌尿外科拟行离断式肾盂成形术的90例UPJO患儿作为研究对象,按随机数表法将患儿分为对照组(45例)和观察组(45例)。对照组接受开放性离断式肾盂成形术治疗,观察组采用腹腔镜离断式肾盂成形术,比较两组围手术期指标、肾盂前后径、肾小球滤过率和并发症发生情况。结果:两组患儿手术均成功。与对照组比较,观察组手术时间与术后止痛药应用时间明显增加,但术中出血量、腹腔引流管留置时间、住院时间、肠道功能恢复时间明显减少,差异有统计学意义(P<0.05)。术后,两组肾盂前后径较术前明显缩小,差异有统计学意义(P<0.05),但两组术后肾盂前后径、肾小球滤过率比较,差异无统计学意义(P>0.05)。两组尿路感染、吻合口尿外渗、恶心、发热、腹胀等并发症发生率比较,差异无统计学意义(P>0.05)。结论:腹腔镜与开放性离断式肾盂成形术治疗UPJO患者均能改善肾积水,而腹腔镜离断式肾盂成形术创伤小、术后恢复时间少。

Objective:To compare the effect of laparoscopic and open dismembered pyeloplasty in the treatment of patients with ureteropelvic junction obstruction(UPJO).Method:A total of 90 children with UPJO who scheduled to undergo dismembered pyeloplasty in Quanzhou Maternal and Child Health Care Hospital·Children's Hospital from October 2020 to April 2022 were selected as the study objects,they were divided into the control group(45 cases)and the observation group(45 cases)by random number table method.The control group was underwent open dismembered pyeloplasty,while the observation group was underwent laparoscopic dismembered pyeloplasty,the perioperative indicators,anteroposterior diameter of renal pelvis,glomerular filtration rate and complications were compared between two groups.Result:The operations were successful in two groups.Compared with the control group,the operation time and postoperative analgesic application time of the observation group were significantly increased,but the intraoperative blood loss and the indwelling time of abdominal drainage tube,hospitalization time and intestinal function recovery time were significantly reduced,and the differences were statistically significant(P<0.05).After operation,the anteroposterior diameter of renal pelvis in two groups were significantly smaller than those before operation,and the differences were statistically significant(P<0.05),however,there were no significant differences in the anteroposterior diameter of renal pelvis and glomerular filtration rate between the two groups(P>0.05).There was no significant difference in the incidence of urinary tract infection,anastomotic urine extravasation,nausea,fever,abdominal distension and other complications between two groups(P>0.05).Conclusion:Both laparoscopic and open dismembered pyeloplasty can improve hydronephrosis in patients with UPJO,while laparoscopic dismembered pyeloplasty has less trauma and less postoperative recovery time.