Li Ning,Zhang Weiping,Tian Jun,et al.Efficacy comparison of Cohen versus Lich-Gregoir ureteral reimplantation for primary vesicoureteral reflux in children[J].Journal of Clinical Pediatric Surgery,2024,(01):29-34.[doi:10.3760/cma.j.cn101785-202311004-006]
腹腔镜Lich-Gregoir术与开放Cohen术治疗儿童原发性膀胱输尿管反流的疗效分析
- Title:
- Efficacy comparison of Cohen versus Lich-Gregoir ureteral reimplantation for primary vesicoureteral reflux in children
- 摘要:
- 目的 探讨腹腔镜Lich-Gregoir术与开放Cohen术在儿童原发性膀胱输尿管反流(vesicoureteral reflux,VUR)治疗中的应用价值。 方法 本研究为回顾性研究,将2018年6月至2022年6月首都医科大学附属北京儿童医院接受手术治疗的150例原发性VUR且资料完整的患儿纳入研究。按照手术方式的不同分为腹腔镜Lich-Gregoir组(n=69)和开放Cohen组(n=81);根据VUR侧别的不同以及术中是否行输尿管裁剪,将腹腔镜Lich-Gregoir组进一步分为单侧未裁剪输尿管腹腔镜Lich-Gregoir组(A组,n=33)、双侧未裁剪输尿管腹腔镜Lich-Gregoir组(C组,n=16)、单侧裁剪输尿管腹腔镜Lich-Gregoir组(E组,n=12)、双侧裁剪一侧输尿管腹腔镜Lich-Gregoir组(G组,n=8),开放Cohen组进一步分为单侧未裁剪输尿管开放Cohen组(B组,n=30)、双侧未裁剪输尿管开放Cohen组(D组,n=20)、单侧裁剪输尿管开放Cohen组(F组,n=18)、双侧裁剪一侧输尿管开放Cohen组(H组,n=13)。将8个亚组配为4对(A组&B组/C组&D组/E组&F组/G组&H组),比较各组性别、年龄、症状、侧别、反流程度、术中以及术后情况。 结果 以上4对进行组内比较,每对当中的两组在性别、年龄、症状、侧别、反流程度方面差异均无统计学意义(P>0.05)。A组、B组的住院时间分别为(6.78±1.76)d和(10.43±1.25)d;C组、D组的住院时间分别为(7.12±2.02)d和(11.05±1.82)d;E组、F组的住院时间分别为(8.83±1.33)d和(11.11±1.27)d;G组、H组的住院时间分别为(8.62±1.59)d和(11.46±1.39)d;差异均有统计学意义(P＜0.05)。A组、B组的手术时间分别为(78.90±12.54)min和(85.60±13.11)min;C组、D组的手术时间分别为(89.43±12.37)min和(99.55±15.14)min;差异均有统计学意义(P＜0.05)。术后6~12个月复查VCUG,共9例出现高级别反流;其中腹腔镜Lich-Gregoir组7例,开放Cohen组2例;2例再次行腹腔镜Lich-Gregoir术,7例行开放Cohen手术,术后均恢复良好。 结论 腹腔镜Lich-Gregoir术和开放Cohen术均为治疗原发性VUR的有效方法。腹腔镜Lich-Gregoir术可以保持输尿管和膀胱的正常生理走行,同时缩短患儿住院时间。对于术中未裁剪输尿管者,腹腔镜Lich-Gregoir术可以缩短手术时间。
- Abstract:
- Objective To compare the outcomes of open intravesical versus extravesical procedures for primary vesicoureteral reflux (VUR) in children.Methods From June 2018 to June 2022,150 children of primary VUR were recruited.According to different surgical appraoches,they are divided into two groups of laparoscopic Lich-Gregoir (n=69) and open Cohen (n=81).According to different of VUR sideness,they were assigned into unilateral and bilateral groups.According to whether or not ureter was resected intraoperatively,laparoscopic Lich-Gregoir group was divided into unilateral uncut ureteral laparoscopic Lich-Gregoir group (group A),bilateral uncut ureteral laparoscopic Lich-Gregoir group (group C),unilateral cut ureteral laparoscopic Lich-Gregoir group (group E) and bilateral cut unilateral ureteral laparoscopic Lich-Gregoir group (group G);Open Cohen group was divided into unilateral uncut ureter open Cohen group (group B),bilateral uncut ureter open Cohen group (group D),unilateral cut ureter open Cohen group (group F) and bilateral cut unilateral ureter open Cohen group (group H).Compare the gender,age,symptoms,side profile,degree of reflux,intraoperative and postoperative conditions between two groups of A/B,C/D,E/F and G/H.Results No statistically significant differences existed in gender,age,symptoms,sideness or severity of reflux.Average hospitalization stay for groups A and B was (6.78±1.76) and (10.43±1.25) day;Average hospitalization stay for groups C and D (7.12±2.02) and (11.05±1.82) day;Average hospitalization time for groups E and F (8.83±1.33) and (11.11±1.27) day;Average hospitalization time of groups G and H (8.62±1.59) and (11.46±1.39) day.The inter-group differences were statistically significant (P<0.05).Surgical durations for groups A and B were (78.90±12.54) and (85.60±13.11) min;Surgical durations for groups C and D (89.43±12.37) and (99.55±15.14) min.The inter-group differences were statistically significant (P<0.05).At Months 6-12 post-operation,voiding cystourethrography (VCUG) was re-examined.Seven cases in laparoscopic Lich-Gregoir group and 2 cases in open Cohen group developed high-grade reflux.Among them,two cases underwent laparoscopic Lich-Gregoir re-surgery and seven cases had open Cohen surgery.The postoperative recovery was excellent.Conclusions Laparoscopic Lich-Gregoir and open Cohen surgery are both efficacious for treating primary VUR.Laparoscopic Lich-Gregoir surgery may maintain normal physiological course of ureter and bladder while shorten hospital stay.For patients without intraoperative ureteral cut,laparoscopic Lich-Gregoir may shorten surgical duration.
参考文献/References:
[1] 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的专家共识[J].临床小儿外科杂志,2019,18(10):811-816.DOI:10.3969/j.issn.1671-6353.2019.10.002. Group of Pediatric Urology,Branch of Pediatric Surgery,Chinese Medical Association:Expert Consensus on Managing 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.
[2] 张北叶.原发性膀胱输尿管反流诊断与治疗的最新趋势[J].临床小儿外科杂志,2019,18(10):817-819.DOI:10.3969/j.issn.1671-6353.2019.10.003. Zhang BY.Recent trends of diagnosing and treating primary vesicoureteral reflux[J].J Clin Ped Sur,2019,18(10):817-819.DOI:10.3969/j.issn.1671-6353.2019.10.003.
[3] Zhong WL,Yao L,Cui HR,et al.Laparoscopic ureteral reimplantation with extracorporeal tailoring and direct nipple ureteroneocystostomy for adult obstructive megaureter:long-term outcomes and comparison to open procedure[J].Int Urol Nephrol,2017,49(11):1973-1978.DOI:10.1007/s11255-017-1687-7.
[4] 王辉,沈颖.儿童原发性膀胱输尿管反流诊治现状及建议[J].中华实用儿科临床杂志,2020,35(5):326-330.DOI:10.3760/cma.j.cn101070-20200225-00244. Wang H,Shen Y.Current status and recommendations for diagnosing and treating primary vesicoureteral reflux in children[J].Chin J Appl Clin Pediatr,2020,35(5):326-330.DOI:10.3760/cma.j.cn101070-20200225-00244.
[5] 李怡,张潍平,杨庆林.儿童原发性膀胱输尿管反流手术治疗新进展[J].临床小儿外科杂志,2019,18(10):805-810.DOI:10.3969/j.issn.1671-6353.2019.10.001. Li Y,Zhang WP,Yang QL.Recent advances of surgery for primary vesicoureteral reflux in children[J].J Clin Ped Sur,2019,18(10):805-810.DOI:10.3969/j.issn.1671-6353.2019.10.001.
[6] Mason MD,Stephany HA,Casella DP,et al.Prospective evaluation of sacral neuromodulation in children:outcomes and urodynamic predictors of success[J].J Urol,2016,195(4 Pt 2):1239-1244.DOI:10.1016/j.juro.2015.11.034.
[7] Soulier V,Scalabre AL,Lopez M,et al.Laparoscopic vesico-ureteral reimplantation with Lich-Gregoir approach in children:medium term results of 159 renal units in 117 children[J].World J Urol,2017,35(11):1791-1798.DOI:10.1007/s00345-017-2064-y.
[8] 黄轶晨,谢华,吕逸清,等.机器人辅助腹腔镜下Lich-Greqoir手术治疗儿童原发性膀胱输尿管反流[J].临床小儿外科杂志,2020,19(2):150-154.DOI:10.3969/j.issn.1671-6353.2020.02.012. Huang YC,Xie H,Lyu YQ,et al.Preliminary experience of robotic assisted laparoscopic ureteral reimplantation in children with primary vesicoureteral reflux[J].J Clin Ped Sur,2020,19(2):150-154.DOI:10.3969/j.issn.1671-6353.2020.02.012.
[9] Ehrlich RM,Gershman A,Fuchs G.Laparoscopic vesicoureteroplasty in children:initial case reports[J].Urology,1994,43(2):255-261.DOI:10.1016/0090-4295(94)90058-2.
[10] Aydin C,Akkoc A,Topaktas R,et al.Comparison of cohen and Lich-Gregoir ureteral reimplantation in the surgical management of primary unilateral vesicoureteral reflux in children[J].Rev Assoc Med Bras (1992),2020,66(4):424-429.DOI:10.1590/1806-9282.66.4.424.
[11] Nabavizadeh B,Keihani S,Hosseini Sharifi SH,et al.Insertion of a single double-J stent for bilateral open ureteral reimplantation:introducing a novel technique and assessment of feasibility[J].Int Urol Nephrol,2016,48(7):1015-1019.DOI:10.1007/s11255-016-1279-y.
[12] Uvin P,Van Baelen A,Verhaegen J,et al.Ureteral stents do not cause bacterial infections in children after ureteral reimplantation[J].Urology,2011,78(1):154-158.DOI:10.1016/j.urology.2010.11.016.
[13] Bustangi N,Kallas Chemaly A,Scalabre A,et al.Extravesical ureteral reimplantation following Lich-Gregoir technique for the correction of vesico-ureteral reflux retrospective comparative study open vs.laparoscopy[J].Front Pediatr,2018,6:388.DOI:10.3389/fped.2018.00388.
[14] 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.
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备注/Memo
收稿日期:2023-10-30。
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:宋宏程,Email:songhch1975@126.com