离断式肾盂输尿管成形术后应用两种引流方式的对照分析
发布时间：2018-12-27 13:54
【摘要】：背景先天性肾积水是小儿泌尿外科较为常见的疾病,发病率占新生儿的1%~2%。肾积水患儿产前彩超均提示肾积水,一般来说,胎儿的泌尿生殖系统会随着孕妇妊娠周期的增加而逐渐成熟,一些新生儿中,轻度肾积水可能会自行消退,肾功能得到改善,但部分中、重度肾积水患儿如得不到及时诊治可能会导致肾功能损害,严重时出现肾功能衰竭[1、2]。因此,肾积水患儿应定期随访,及时手术,以免延误患儿病情。小儿先天性肾积水的手术治疗原则首选离断式肾盂输尿管成形术,手术切除影响肾盂积水的原因,进而达到缓解患儿肾积水的目的。术后常规留置引流管引流尿液,避免术后出现输尿管狭窄至再次肾积水可能。目前常用内引流和外引流两种方法,本文通过分析比较肾积水术后两种引流方法的手术和住院时间、术中出血量、并发症以及术后随访情况来探讨两种引流方式的优缺点。目的探讨双J管内引流和外引流两种方式在肾积水术后应用的优缺点。方法收集我院2013年1月-2016年1月收治的肾积水患儿的临床资料,共62例,男50例,女12例,年龄范围在1月~12岁,平均年龄2.54岁;左侧40例,右侧22例;根据术后引流方式分为内引流组(双J管、肾周引流管)36例,男28例,女8例;左侧24例,右侧12例;外引流组(肾盂引流管、输尿管支架管、肾周引流管)26例,男22例,女4例;左侧16例,右侧10例。根据胎儿泌尿外科协会肾积水分级(society of fetal urology grading system)标准,肾积水手术指征为集合区分离(antero-posterio,AP)20mm,且伴有肾盏扩张者。其中内引流组轻度0例,中度1例,重度35例;外引流组轻度0例,中度5例,重度21例。全部手术病例均伴肾盏扩张;术后病理结果均证实为输尿管连接处梗阻。比较两组一般情况、手术时间、住院时间、术中出血量和术后并发症以及随访肾积水术后的恢复情况。对两组疗效进行评估,并进行统计学分析。结果1、两组在年龄、性别、侧别上对比差异无统计学意义(P0.05)。2、内引流组手术时间平均为75.83±12.50min;术中出血量平均为11.89±8.26ml,平均住院时间为13.75±5.22d,泌尿系感染1例,术后3天腹痛2例,吻合口狭窄2例,结石1例,术后血尿时间为2.67±2.04d。3、外引流组手术时间平均为93.46±19.17min;术中出血量平均为15.15±13.86ml,平均住院时间为22.27±6.90d,泌尿系感染3例,术后3天腹痛8例,吻合口狭窄2例,结石0例,术后血尿时间为2.65±1.77d。4、两组在手术时间、住院时间和术后并发症总发生率上相比差异有统计学意义(P0.05);在术中出血量、术后血尿、泌尿系感染、结石等单方面相比,差异无统计学意义(P0.05)。结论离断式肾盂输尿管成形术后双J管内引流缩短了手术和住院时间,减少了术后并发症。
[Abstract]:Background congenital hydronephrosis is a common disease in pediatric urology. In general, the fetal genitourinary system matures gradually with the increase of pregnant women's pregnancy cycle. In some newborns, mild hydronephrosis may recede and renal function can be improved. But in some cases, severe hydronephrosis may lead to renal dysfunction without timely diagnosis and treatment, and renal failure may occur in severe cases. Therefore, hydronephrosis children should be regularly followed up, timely surgery, so as not to delay the condition of children. The principle of surgical treatment for congenital hydronephrosis in children is the first choice of dissociated ureteropelvic angioplasty. Surgical resection of hydronephrosis affects the causes of hydronephrosis so as to alleviate the hydronephrosis in children. After operation, the drainage tube was used to drain urine to avoid ureteral stricture to rehydronephrosis. At present, there are two kinds of drainage methods: internal drainage and external drainage. The advantages and disadvantages of the two drainage methods were discussed by comparing the operation and hospitalization time, intraoperative bleeding volume, complications and postoperative follow-up of the two drainage methods after hydronephrosis. Objective to investigate the advantages and disadvantages of double J tube internal drainage and external drainage in postoperative hydronephrosis. Methods the clinical data of 62 children with hydronephrosis from January 2013 to January 2016 were collected. There were 50 males and 12 females, with an average age of 2.54 years, 40 cases on the left and 22 cases on the right. According to the postoperative drainage mode, 36 cases were divided into two groups (double J tube, perirenal drainage tube), male 28 cases, female 8 cases, left 24 cases, right 12 cases, left side 24 cases, right 12 cases, left 24 cases, right 12 cases. 26 cases (22 males, 4 females) in the external drainage group (renal pelvis drainage tube, ureteral stent tube, perirenal drainage tube), left 16 cases, right 10 cases. According to the (society of fetal urology grading system) standard of hydronephrosis grade of fetal urology association, hydronephrosis was characterized by separation of collecting area (antero-posterio,AP) 20 mm, and accompanied by dilatation of renal calyceal. There were 0 mild cases, 1 moderate case and 35 severe cases in the internal drainage group, while in the external drainage group, there were 0 mild cases, 5 moderate cases and 21 severe cases. All cases were accompanied by renal calcaneal dilatation, and the postoperative pathological results were confirmed as ureteral junction obstruction. The general condition, operation time, hospital stay, intraoperative bleeding and postoperative complications were compared between the two groups, and the recovery of hydronephrosis was followed up. The curative effect of the two groups was evaluated and statistically analyzed. Results 1. There was no significant difference in age, sex and side sex between the two groups (P0.05). The average operative time of the internal drainage group was 75.83 卤12.50 min. The average amount of blood loss during operation was 11.89 卤8.26 ml, the average hospital stay was 13.75 卤5.22 days, urinary tract infection occurred in 1 case, abdominal pain in 2 cases, anastomotic stricture in 2 cases, stone in 1 case, postoperative hematuria time was 2.67 卤2.04d.3. The average operative time of external drainage group was 93.46 卤19.17 min. The average amount of blood loss during operation was 15.15 卤13.86 ml, the average hospital stay was 22.27 卤6.90 days, urinary tract infection occurred in 3 cases, abdominal pain in 8 cases, anastomotic stenosis in 2 cases, stone in 0 cases, and hematuria time was 2.65 卤1.77 d.4. There were significant differences between the two groups in the operation time, hospital stay and the total incidence of postoperative complications (P0.05). There was no significant difference in intraoperative bleeding, postoperative hematuria, urinary tract infection, stone and other unilateral differences (P0.05). Conclusion double J tube drainage can shorten the operation and hospitalization time and reduce postoperative complications.
【学位授予单位】：新乡医学院
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R726.9
[Abstract]:Background congenital hydronephrosis is a common disease in pediatric urology. In general, the fetal genitourinary system matures gradually with the increase of pregnant women's pregnancy cycle. In some newborns, mild hydronephrosis may recede and renal function can be improved. But in some cases, severe hydronephrosis may lead to renal dysfunction without timely diagnosis and treatment, and renal failure may occur in severe cases. Therefore, hydronephrosis children should be regularly followed up, timely surgery, so as not to delay the condition of children. The principle of surgical treatment for congenital hydronephrosis in children is the first choice of dissociated ureteropelvic angioplasty. Surgical resection of hydronephrosis affects the causes of hydronephrosis so as to alleviate the hydronephrosis in children. After operation, the drainage tube was used to drain urine to avoid ureteral stricture to rehydronephrosis. At present, there are two kinds of drainage methods: internal drainage and external drainage. The advantages and disadvantages of the two drainage methods were discussed by comparing the operation and hospitalization time, intraoperative bleeding volume, complications and postoperative follow-up of the two drainage methods after hydronephrosis. Objective to investigate the advantages and disadvantages of double J tube internal drainage and external drainage in postoperative hydronephrosis. Methods the clinical data of 62 children with hydronephrosis from January 2013 to January 2016 were collected. There were 50 males and 12 females, with an average age of 2.54 years, 40 cases on the left and 22 cases on the right. According to the postoperative drainage mode, 36 cases were divided into two groups (double J tube, perirenal drainage tube), male 28 cases, female 8 cases, left 24 cases, right 12 cases, left side 24 cases, right 12 cases, left 24 cases, right 12 cases. 26 cases (22 males, 4 females) in the external drainage group (renal pelvis drainage tube, ureteral stent tube, perirenal drainage tube), left 16 cases, right 10 cases. According to the (society of fetal urology grading system) standard of hydronephrosis grade of fetal urology association, hydronephrosis was characterized by separation of collecting area (antero-posterio,AP) 20 mm, and accompanied by dilatation of renal calyceal. There were 0 mild cases, 1 moderate case and 35 severe cases in the internal drainage group, while in the external drainage group, there were 0 mild cases, 5 moderate cases and 21 severe cases. All cases were accompanied by renal calcaneal dilatation, and the postoperative pathological results were confirmed as ureteral junction obstruction. The general condition, operation time, hospital stay, intraoperative bleeding and postoperative complications were compared between the two groups, and the recovery of hydronephrosis was followed up. The curative effect of the two groups was evaluated and statistically analyzed. Results 1. There was no significant difference in age, sex and side sex between the two groups (P0.05). The average operative time of the internal drainage group was 75.83 卤12.50 min. The average amount of blood loss during operation was 11.89 卤8.26 ml, the average hospital stay was 13.75 卤5.22 days, urinary tract infection occurred in 1 case, abdominal pain in 2 cases, anastomotic stricture in 2 cases, stone in 1 case, postoperative hematuria time was 2.67 卤2.04d.3. The average operative time of external drainage group was 93.46 卤19.17 min. The average amount of blood loss during operation was 15.15 卤13.86 ml, the average hospital stay was 22.27 卤6.90 days, urinary tract infection occurred in 3 cases, abdominal pain in 8 cases, anastomotic stenosis in 2 cases, stone in 0 cases, and hematuria time was 2.65 卤1.77 d.4. There were significant differences between the two groups in the operation time, hospital stay and the total incidence of postoperative complications (P0.05). There was no significant difference in intraoperative bleeding, postoperative hematuria, urinary tract infection, stone and other unilateral differences (P0.05). Conclusion double J tube drainage can shorten the operation and hospitalization time and reduce postoperative complications.
【学位授予单位】：新乡医学院
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R726.9
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