经脐三通道腹腔镜下Anderson-Hynes术式治疗小儿UPJ0的应用价值

发布时间：2019-04-28 15:34

【摘要】：研究背景肾积水,是一种较多见的小儿泌尿系统先天性畸形。临床上有近90%的肾积水是由UPJ0(肾盂输尿管连接处梗阻)引起的。小儿肾积水的治疗方式包括保守治疗和手术治疗,而手术治疗方式应用最多的是Anderson-Hynes(离断式肾盂成形术)术式,该术式一经出现就立即成为了肾积水治疗的标准术式。开放肾盂离断式成形术治疗肾盂输尿管连接处梗阻一次性成功率可达到90%以上。而文献报道后腹腔镜术式治疗小儿肾积水的一次性成功率和开放术式相当。但后腹腔镜途径仍然存在着手术空间小、不太适用于治疗复杂或再次手术的肾积水患儿、术后手术瘢痕仍较明显的缺点。目的本研究旨在探讨经腹三通道腹腔镜下离断式肾盂成形术治疗小儿肾积水的临床疗效及预后,并比较其和后腹腔镜途径的优缺点,探讨该手术方式用于治疗由UPJ0引起的小儿肾积水的临床应用价值。方法选取本中心2013年9月至2015年4月经超声、MRU检查确诊为由UPJ0引起的单侧重度肾积水患儿59例,随访时间为6-12个月。分为实验组和对照组:实验组(经脐三通道腹腔镜途径34例),对照组(后腹腔镜途径25例)。收集实验组和对照组两组患儿性别、手术年龄和患肾部位、手术时间、术中出血量、术中有无更改手术方式、平均住院日、术前和术后的肾盂前后径、GFR(肾小球滤过率)等手术相关资料。并对两组记录的数据进行统计学分析。结果两组患儿手术均顺利完成,术中未更改开放手术,无严重手术并发症状,无死亡病例,两组各有1例患儿术后复查提示再次梗阻,再次手术后未再出现梗阻,遂这2例患儿的数据采用的是第2次手术的数据。随访时间为6-12个月。实验组和对照组组内肾盂前后径和肾小球滤过率两指标手术前后的数据做两样本配对样本t检验,各P值均小于0.05,表明两组组内手术前后有明显差异,两种途径手术疗效肯定。最后,分别将两组内数据差值差做两配对样本t检验,检验结果显示所有指标治疗前后均无统计学差异(P0.05)。表明两种手术途径治疗由UPJ0引起的小儿重度肾积水的疗效无显著差别,疗效相当。结论经脐三通道腹腔镜下离断式肾盂成形术手术疗效与后腹腔镜途径相当,而手术空间更大,对于二次或者多次手术的患儿优势更加明显,术后伤口瘢痕不明显,美容效果更佳,具有较大的临床应用价值。
[Abstract]:Background hydronephrosis is a common congenital malformation of urinary system in children. Nearly 90% of hydronephrosis is caused by UPJ0 (ureteropelvic junction obstruction). The treatment of hydronephrosis in children includes conservative treatment and surgical treatment. Anderson-Hynes (dissected pyeloplasty) is the most commonly used surgical treatment, which has become the standard procedure for hydronephrosis as soon as it appears. The one-time success rate of open pyeloplasty for ureteropelvic junction obstruction was more than 90%. The one-time success rate of posterior laparoscopy in the treatment of hydronephrosis in children is the same as that of open operation. However, retrolaparoscopic approach still has small operative space, which is not suitable for the treatment of complicated or re-operated hydronephrosis in children, and postoperative scar is still obvious shortcomings. Objective to investigate the clinical efficacy and prognosis of three-channel laparoscopic pyeloplasty in children with hydronephrosis, and to compare its advantages and disadvantages with that of retroperitoneal laparoscopic approach. To evaluate the clinical value of this method in the treatment of hydronephrosis caused by UPJ0 in children. Methods from September 2013 to April 2015, 59 children with unilateral severe hydronephrosis diagnosed by MRU were selected. The follow-up period was 6 months and 12 months. They were divided into experimental group (n = 34) and control group (n = 25). The sex, the age of operation, the location of the kidney, the time of operation, the amount of bleeding during the operation, the average length of hospitalization, the anterior and posterior diameter of renal pelvis before and after operation were collected in the experimental group and the control group, and whether there were any changes in the operation mode during the operation. GFR (glomerular filtration rate) and other surgical data. The data recorded in the two groups were analyzed statistically. Results the operation was successfully completed in the two groups. The open operation was not changed during the operation. There were no serious complications and no death cases in the two groups. One case in each group showed re-obstruction after operation, and there was no further obstruction after the re-operation. The data of the two cases were based on the data of the second operation. The follow-up period was 6 to 12 months. The pre-and post-operative data of renal pelvis diameter and glomerular filtration rate in the experimental group and the control group were tested by paired sample t test with two samples, each P < 0.05, indicating that there was a significant difference between the two groups before and after the operation, and that there was a significant difference between the two groups before and after the operation. The curative effect of the two approaches is definite. Finally, the difference of data between the two groups was matched by two pairs of t-test, the results showed that there was no statistical difference before and after treatment (P0.05). The results showed that there was no significant difference between the two surgical approaches in the treatment of severe hydronephrosis caused by UPJ0. Conclusion the curative effect of three-channel laparoscopic disconnection pyeloplasty is similar to that of retroperitoneal laparoscopy, but the operation space is larger, the advantage is more obvious for the second or multiple operations in children, and the wound scar is not obvious after operation, and the curative effect is similar to that of retroperitoneal laparoscopic pyeloplasty. The cosmetic effect is better and has great clinical application value.
【学位授予单位】：南方医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R726.9

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