D-J管在儿童肾盂成形术中的应用分析——倾向性评分匹配法

Application Effect and Prognosis Analysis of D-J Tube in Pediatric Pyeloplasty-Propensity Score Matching

目的 D-J管内引流方法在儿童肾盂成形手术后使用中的适应证及预后分析。方法 回顾性分析2012年1月~2022年1月在首都儿科研究所泌尿外科行单侧肾盂成形术的病例,根据术后引流方式不同分为D-J管组(396例)和肾盂造瘘组(334例),应用倾向性评分匹配法对两组病例的基线资料均衡匹配,比较两种引流方式的并发症及预后。结果 D-J管引流能显著减少患者平均住院时间、降低患儿痛苦、减轻皮肤瘢痕,提高医疗及护理质量。D-J管增加患儿术后泌尿道感染和再梗阻风险,临床应用应谨慎。对于D-J管植入术后泌尿道感染建立了包含性别、侧别、身高、肾实质厚度和血尿素氮的预测模型。结论 D-J管内引流方法能显著降低儿童肾盂成形手术后的住院时间、减轻护理负担,虽然这增加了患者近中期尿路感染的风险,但尿路感染的风险可以预测,D-J管在男性、小婴儿和重度肾积水的应用中应谨慎选择。

Objective To analyze the indications and prognosis of the D-J tube internal drainage method in pediatric pyeloplasty surgery.Methods We conducted a retrospective analysis of cases of unilateral pyeloplasty performed in the urology department of the Capital Institute of Pediatrics from January 2012 to January 2022.They were divided into the D-J tube group(396 cases)and the pyelostomy group(334 cases)according to different postoperative drainage methods.The propensity score matching method was used to evenly match the baseline data of the two groups of cases,and the complications and prognosis of the two drainage methods were compared.Results D-J tube drainage could significantly reduce the average hospitalization time,reduce pain,alleviate skin scars,and improve the quality of medical care and care.D-J tube could increase the risk of postoperative urinary tract infection and re-obstruction in children,and clinical application should be cautious.A predictive model was established for urinary tract infections after D-J tube implantation,including gender,side profile,height,renal parenchymal thickness,and blood urea nitrogen.Conclusion The D-J tube internal drainage method can significantly reduce the length of hospital stay and nursing burden after pediatric pyeloplasty surgery.Although it may increase the risk of urinary tract infection in the near and medium term,the risk of urinary tract infection can be predicted.The use of D-J tubes should be carefully selected in males,small infants,and severe hydronephrosis.