He Yuzhu,Li Jiayi,Song Hongcheng,et al.Comparative analysis of complications between open and laparoscopic pyeloplasty for congenital ureteropelvic junction obstructive hydronephrosis in children[J].Journal of Clinical Pediatric Surgery,,():315-322.[doi:10.3760/cma.j.cn101785-202403060-004]
Comparative analysis of complications between open and laparoscopic pyeloplasty for congenital ureteropelvic junction obstructive hydronephrosis in children
- Keywords:
- Ureteropelvic Junction Obstruction; Laparoscopy; Urologic Surgical Procedures; Hydronephrosis; Intraoperative Complications; Postoperative Complications; Child
- Abstract:
- Objective To compare the perioperative complications and explore the potential factors contributing to the differences in complications between laparoscopic and open dismembered pyeloplasty for congenital ureteropelvic junction obstructive hydronephrosis in children. Methods Between July 2016 and December 2018,retrospective review was conducted for all children with ureteropelvic junction obstruction (UPJO) undergoing primary transperitoneal laparoscopic pyeloplasty (LP) and retroperitoneal open pyeloplasty (OP) Perioperative complications were compared between LP and OP.Complication rate,Clavien-Dindo grade and types were compared.Complications were also compared between different postoperative drainage modes and groups with or without intraoperative complications.Also the differences in postoperative complications were explored among groups with varying age,weight,anterioposterior pelvic diameter (APD) and surgeon expertise. Results For 583 UPJO kidneys,LP was performed for 355 kidneys and OP for 228 kidneys.The median age of the open group was 16.37 months (9.73 months,61.37 months) and the median weight was 11.00 kg (9.30 kg,20.00 kg), which were significantly lower than the median age of the laparoscopic group,which was 46.87 months (19.08 months,90.49 months),and the median weight of 16.50 kg (12.00 kg,25.00 kg). The median preoperative renal pelvis anteroposterior diameter in the open group was 39.00 mm (27.00 mm,52.00 mm), significantly larger than that of the laparoscopic group,which was 28.00 mm (22.00 mm,36.00 mm).These differences were statistically significant (P<0.05).The inter-group incidence of intraoperative complications showed no significant difference (LP:7.61% vs OP:4.39%).Also no significant inter-group difference existed in restenosis of anastomotic rate (LP:2.62% vs.OP:1.33%).Although no significant inter-group difference in the incidence or frequency of postoperative complications,types of complications differed.Urinary tract infections (UTIs) dominated in both groups.Kidneys with intraoperative complications were more prone to higher grades of postoperative complications (χ2=5.600,P=0.018) and UTIs (χ2=8.891,P=0.003).As compared with OP group,LP group showed a higher propensity for high-grade postoperative complications (Clavien Ⅲb) (χ2=6.595,P=0.010) and other complications (χ2=10.289,P=0.001),except for UTIs. Conclusions LP and OP are both safe and effective in UPJO children.However,types of complications differ.As compared with OP,LP requires a higher alert for the occurrence of complications and high-grade postoperative complications,except for UTIs.
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Memo
收稿日期:2023-12-27。
基金项目:北京市科委、中关村管委会"医药创新品种及平台培育"专项资助(Z231100004823034)
通讯作者:张潍平,Email:zhangwpp@163.com