Li Hu,Chao Min,Jiang Jiabin,et al.Analysis of risk factors of unplanned reoperation after laparoscopic pyeloplasty[J].Journal of Clinical Pediatric Surgery,,():328-334.[doi:10.3760/cma.j.cn101785-202403060-006]
Analysis of risk factors of unplanned reoperation after laparoscopic pyeloplasty
- Keywords:
- Ureteropelvic Junction Obstruction; Laparoscopy; Pyeloplasty; Postoperative Complications; Reoperation; Root Cause Analysis; Child
- Abstract:
- Objective To explore the risk factors of unplanned reoperation (UR) after laparoscopic pyeloplasty (LP) in children with ureteropelvic junction obstruction (UPJO) and examine the clinical characteristics of UR children. Methods From March 2010 to December 2023,the relevant clinical data were retrospectively reviewed for 678 children of unilateral UPJO undergoing LP.Children undergoing UR after LP were selected as study group and those without UR as control group.Gender,age,history of nephrostomy,Society of Fetal Urology (SFU) grade,surgical proficiency and postoperative hospitalization stay of two groups were collected for univariate and multivariate Logistic regression analyses.Statistical analysis was performed with SPSS version 26.0 software package. Results Among them,19(2.8%) cases underwent UR.According to the timing of reoperation,it was assigned into short-term and long-term URs.Four children (4/678,0.6%) underwent short-term UR for uroabdomen and allantois due to anastomotic leakage,varying degrees of intestinal obstruction and abdominal infection.Long-term UR was performed in 15 children (15/678,2.2%) for recurrent UPJO,aggravation of hydronephrosis,recurrent abdominal pain,urinary tract infection and hematuria.According to univariate analysis,anteroposterior diameter (APD),postoperative hospitalization stay,surgical proficiency,preoperative severity of hydronephrosis and presence of percutaneous nephrostomy were associated with UR (P<0.05).Based upon multivariable analysis,APD (OR=1.278,95%CI:1.069-1.528),postoperative hospitalization stay (OR=1.165,95%CI:1.094-1.239),surgical proficiency (OR=1.165,95%CI:1.094-1.239) and presence of percutaneous nephrostomy (OR=17.817,95%CI:3.291-96.446) were the strongest predictors of UR (P<0.05). Conclusions APD,postoperative hospitalization stay,surgical proficiency and presence of percutaneous nephrostomy are correlated with UR.Timely renal ultrasonography,evaluation of renal function,accurate intraoperative handling and a lowered risk of complications are vital for preventing and minimizing UR.
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Memo
收稿日期:2024-01-21。
基金项目:安徽省科技厅临床医学转化项目(202304295107020066)
通讯作者:张殷,Email:zhangyincx@163.com