Zhang Dongzheng,Wang Xin,Wu Yong,et al.Efficacy analysis of Lich-Gregoir laparoscopy for primary vesicoureteral reflux in toddlers[J].Journal of Clinical Pediatric Surgery,2026,(01):49-54.[doi:10.3760/cma.j.cn101785-202503120]
Efficacy analysis of Lich-Gregoir laparoscopy for primary vesicoureteral reflux in toddlers
- Keywords:
- Vesicoureteral Reflux; Urinary Bladder; Neurogenic; Laparoscope; Surgical Procedure; Operative; Child
- Abstract:
- Objective To explore the efficacy and application value of Lich-Gregoir laparoscopy for primary vesicoureteral reflux (PVUR) in toddlers. Methods A retrospective analysis was conducted for the clinical data of 67 PVUR children undergoing Lich-Gregoir laparoscopy from January 2017 to June 2024.Based upon age and unilaterality or bilaterality,they were assigned into unilateral reflux aged under 3 years (group A,n=15),bilateral reflux aged under 3 years (group B,n=18),unilateral reflux aged 3 years and above (group C,n=18) and bilateral reflux aged 3 years and above (group D,n=16).Four subgroups were paired into two pairs (group A & group C,group B & group D).The relevant clinical data such as gender,body mass index (BMI),reflux sideness,reflux grade,intraoperative findings and postoperative complications of each group were compared. Results While comparing two groups,operative duration of groups A and C was (92.27±15.57) and (115.39±18.92) min and intraoperative blood loss (5.27±1.83) and (13.56±2.36) mL.Operative duration of groups B and D was (120.61±26.67) and (160.19±22.86) min and volume of intraoperative blood loss (11.50±2.60) and (25.00±2.94) mL respectively.The inter-group differences were statistically significant (P<0.05).No statistical significances existed in gender,BMI,reflux sideness,reflux grade,duration of drainage tube,duration of urinary catheterization,postoperative hospital stay,duration of indwelling double-J stent,postoperative acute urinary retention,urinary tract infection (UTI) during double-J stenting,UTI after removal of double-J stent,recurrence of low-grade reflux and high-grade reflux (P>0.05). Conclusions Lich-Gregoir laparoscopy is both safe and efficacious for PVUR in toddlers.As compared with elder children,it offers the advantages of shorter operative duration and less volume of intraoperative blood loss.
References:
[1] 杨屹,刘鑫.关于儿童膀胱输尿管反流治疗中的几个焦点问题[J].临床小儿外科杂志,2023,22(10):901-907.DOI:10.3760/cma.j.cn101785-202302027-001. Yang Y,Liu X.Several focal issues in the treatment of vesicoureteral reflux in children[J].DOI:10.3760/cma.j.cn101785-202302027-001.
[2] 中华医学会小儿外科学分会泌尿外科学组.儿童原发性膀胱输尿管反流专家共识[J].临床小儿外科杂志,2019,18(10):811-816.DOI:10.3969/j.issn.1671-6353.2019.10.002. Pediatrie Urology Group,Branch of Pediatrie Surgery,Chinese Medical Association.Expert consensus on management of primary vesicoureteral reflux in children[J].J Clin Ped Sur,2019,18(10):811-816.DOI:10.3969/j.issn.1671-6353.2019.10.002.
[3] Guler Y,Erbin A,Ozmerdiven G.Modified Lich-Gregoir ureteral reimplantation for the treatment of unilateral primary vesicoureteral reflux in pediatric patients:a comparative analysis with Medium-Term outcomes[J].Urol J,2020,18(2):194-198.DOI:10.22037/uj.v16i7.5784.
[4] Kirsch AJ,Arlen AM.Evolving surgical management of pediatric vesicoureteral reflux:is open ureteral reimplantation still the ‘Gold Standard’?[J].Int Braz J Urol,2020,46(3):314-321.DOI:10.1590/S1677-5538.IBJU.2020.99.05.
[5] Skoog SJ,Peters CA,Arant BSJ,et al.Pediatric vesicoureteral reflux guidelines panel summary report:clinical practice guidelines for screening siblings of children with vesicoureteral reflux and neonates/infants with prenatal hydronephrosis[J].J Urol,2010,184(3):1145-1151.DOI:10.1016/j.juro.2010.05.066.
[6] Capozza N,Gulia C,Heidari Bateni Z,et al.Vesicoureteral reflux in infants:what do we know about the gender prevalence by age?[J].Eur Rev Med Pharmacol Sci,2017,21(23):5321-5329.DOI:10.26355/eurrev_201712_13916.
[7] Silay MS,Turan T,Kayal? Y,et al.Comparison of intravesical (Cohen) and extravesical (Lich-Gregoir) ureteroneocystostomy in the treatment of unilateral primary vesicoureteric reflux in children[J].J Pediatr Urol,2018,14(1):65.e1-65.e4.DOI:10.1016/j.jpurol.2017.09.014.
[8] Montanaro B,Botto N,Broch A,et al.Asymmetrical primary vesicoureteral reflux:which is the best surgical strategy?[J].J Pediatr Urol,2024,20(6):1213-1218.DOI:10.1016/j.jpurol.2024.09.011.
[9] Rivera Pereira BMY,Landa Juárez S,Márquez González H.Laparoscopic Lich-Gregoir ureteroneocystostomy versus open surgery:are there benefits from the minimally invasive procedure?[J].J Pediatr Urol,2024,21(2):384-388.DOI:10.1016/j.jpurol.2024.11.002.
[10] Lakshmanan Y,Fung LC.Laparoscopic extravesicular ureteral reimplantation for vesicoureteral reflux:recent technical advances[J].J Endourol,2000,14(7):589-593; discussion 593-4.DOI:10.1089/08927790050152203.
[11] Gill IS,Ponsky LE,Desai M,et al.Laparoscopic cross-trigonal cohen ureteroneocystostomy:novel technique[J].J Urol,2001,166(5):1811-1814.DOI:10.1016/S0022-5347(05)65680-7.
[12] Lopez M,Varlet F.Laparoscopic extravesical transperitoneal approach following the Lich-Gregoir technique in the treatment of vesicoureteral reflux in children[J].J Pediatr Surg,2010,45(4):806-810.DOI:10.1016/j.jpedsurg.2009.12.003.
[13] Uluocak N,Erdemir F,Parlaktas BS,et al.Bladder wall thickness in healthy school-aged children[J].Urology,2007,69(4):763-766.DOI:10.1016/j.urology.2006.03.086.
[14] Houle AM,McLorie GA,Heritz DM,et al.Extravesical nondismembered ureteroplasty with detrusorrhaphy:a renewed technique to correct vesicoureteral reflux in children[J].J Urol,1992,148(2 Pt 2):704-707.DOI:10.1016/s0022-5347(17)36699-5.
[15] 李骥,张谦,郭立华,等.腹腔镜经膀胱内外2种途径修复儿童输尿管膀胱连接部畸形效果评价[J].中华实用儿科临床杂志,2021,36(19):1501-1505.DOI:10.3760/cma.j.cn101070-20200103-0007. Li J,Zhang Q,Guo LH,et al.Evaluation on the laparoscopic repair in children with ureterovesical junction malformation through internal or external bladder[J].Chin J Appl Clin Pediatr,2021,36(19):1501-1505.DOI:10.3760/cma.j.cn101070-20200103-0007.
[16] Riquelme M,Lopez M,Landa S,et al.Laparoscopic extravesical ureteral reimplantation (LEVUR):a multicenter experience with 95 cases[J].Eur J Pediatr Surg,2013,23(2):143-147.DOI:10.1055/s-0032-1329708.
[17] Panaretto K,Craig J,Knight J,et al.Risk factors for recurrent urinary tract infection in preschool children[J].J Paediatr Child Health,1999,35(5):454-459.DOI:10.1046/j.1440-1754.1999.355417.x.
[18] Imam MS,Al Farooq MA,Sarwar MKA,et al.A comparison between short-and long-term D-J stent in Anderson-Hynes pyeloplasty for pelvi-ureteric junction obstruction[J].Pediatr Surg Int,2020,36(11):1363-1370.DOI:10.1007/s00383-020-04734-9.
[19] Ozgur BC,Ek?c? M,Yuceturk CN,et al.Bacterial colonization of double J stents and bacteriuria frequency[J].Kaohsiung J Med Sci,2013,29(12):658-661.DOI:10.1016/j.kjms.2013.01.017.
[20] Vlastarakos PV,Nikolopoulos TP,Maragoudakis P,et al.Biofilms in ear,nose,and throat infections:how important are they?[J].Laryngoscope,2007,117(4):668-673.DOI:10.1097/MLG.0b013e318030e422.
[21] Bayne AP,Shoss JM,Starke NR,et al.Single-center experience with pediatric laparoscopic extravesical reimplantation:safe and effective in simple and complex anatomy[J].J Laparoendosc Adv Surg Tech A,2012,22(1):102-106.DOI:10.1089/lap.2011.0299.
[22] Leissner J,Allhoff EP,Wolff W,et al.The pelvic plexus and antireflux surgery:topographical findings and clinical consequences[J].J Urol,2001,165(5):1652-1655.
[23] Yucel S,Baskin LS.Neuroanatomy of the ureterovesical junction:clinical implications[J].J Urol,2003,170(3):945-948.DOI:10.1097/01.ju.0000082728.20298.ac.
[24] David S,Kelly C,Poppas DP.Nerve sparing extravesical repair of bilateral vesicoureteral reflux:description of technique and evaluation of urinary retention[J].J Urol,2004,172(4 Pt 2):1617-1620.DOI:10.1097/01.ju.0000139951.37492.91.
Memo
收稿日期:2025-3-31。
基金项目:天津市医学重点学科(专业)建设项目(TJYXZDXK—040A);天津市第二批卫生健康行业高层次人才选拔培养工程(TJSQNYXXR—D2—069)
通讯作者:关勇,Email:guanyongyisheng@163.com