Liu Xin,Yang Yi.Understandings and reflections on surgical complications of ureteropelvic junction obstruction[J].Journal of Clinical Pediatric Surgery,2024,(04):305-309.[doi:10.3760/cma.j.cn101785-202403060-002]
儿童肾盂输尿管连接处梗阻手术并发症的认识与思考
- Title:
- Understandings and reflections on surgical complications of ureteropelvic junction obstruction
- Keywords:
- Ureteropelvic Junction Obstruction; Intraoperative Complications; Postoperative Complications; Diagnosis; Therapy; Child
- 摘要:
- 肾盂输尿管连接处梗阻是儿童最常见的先天性上尿路梗阻,离断式肾盂输尿管成形术是治疗该病的金标准,手术成功率达90%以上。然而如何避免手术并发症(特别是严重并发症)仍然充满了挑战。随着外科技术的不断创新,外科医师应在更精准把握手术指征、全面认识和正确处理手术并发症上提高认识,从而使患儿从手术治疗中最大化获益。本文阐述肾盂输尿管连接处梗阻患儿肾盂输尿管成形术后并发症的类型、病因、预防和处理,并对相关危险因素提出思考。
- Abstract:
- Ureteropelvic junction obstruction (UPJO) has been the most common congenital cause of upper urinary tract obstruction.And dismembered pyeloplasty continues to be a gold standard with an overall success rate of 90%.However,a proper management of surgical complications remains rather challenging.As surgical techniques continue innovating,surgeons should be more precise about the indications for surgery and more comprehensively understand and correctly manage surgical complications to maximize patient benefits.This review summarized the complications of pyeloplasty from the perspectives of types,causes,preventions and risk factors.
参考文献/References:
[1] Sal? M,Sj?berg Altemani T,Anderberg M.Pyeloplasty in children:perioperative and long-term outcomes of robotic-assisted laparoscopic surgery compared results to open surgery[J].Pediatr Surg Int,2016,32(6):599-607.DOI:10.1007/s00383-016-3869-2.
[2] Eden CG.Minimally invasive treatment of ureteropelvic junction obstruction:a critical analysis of results[J].Eur Urol,2007,52(4):983-989.DOI:10.1016/j.eururo.2007.06.047.
[3] Peters CA,Schlussel RN,Retik AB.Pediatric laparoscopic dismembered pyeloplasty[J].J Urol,1995,153(6):1962-1965.
[4] Tan BJ,Rastinehad AR,Marcovich R,et al.Trends in ureteropelvic junction obstruction management among urologists in the United States[J].Urology,2005,65(2):260-264.DOI:10.1016/j.urology.2004.09.051.
[5] Satava RM.Identification and reduction of surgical error using simulation[J].Minim Invasive Ther Allied Technol,2005,14(4):257-261.DOI:10.1080/13645700500274112.
[6] Clavien PA,Barkun J,de Oliveira ML,et al.The Clavien-Dindo classification of surgical complications:five-year experience[J].Ann Surg,2009,250(2):187-196.DOI:10.1097/SLA.0b013e3181b13ca2.
[7] Fedelini P,Verze P,Meccariello C,et al.Intraoperative and postoperative complications of laparoscopic pyeloplasty:a single surgical team experience with 236 cases[J].J Endourol,2013,27(10):1224-1229.DOI:10.1089/end.2013.0301.
[8] Rassweiler JJ,Teber D,Frede T.Complications of laparoscopic pyeloplasty[J].World J Urol,2008,26(6):539-547.DOI:10.1007/s00345-008-0266-z.
[9] Sheth K,Puttmann K,Nichols P,et al.Does prophylactic antibiotics post pediatric pyeloplasty reduce the incidence of febrile UTIs?[J].BMC Urol,2023,23(1):133.DOI:10.1186/s12894-023-01301-x.
[10] Huang YD,Wu Y,Shan W,et al.An updated meta-analysis of laparoscopic versus open pyeloplasty for ureteropelvic junction obstruction in children[J].Int J Clin Exp Med,2015,8(4):4922-4931.
[11] Vidovic S,Hayes T,Fowke J,et al.Pyeloplasty with ureteral stent placement in children:Do prophylactic antibiotics serve a purpose?[J].J Pediatr Urol,2022,18(6):804-811.DOI:10.1016/j.jpurol.2022.03.022.
[12] Kehinde EO,Rotimi VO,Al-Awadi KA,et al.Factors predisposing to urinary tract infection after J ureteral stent insertion[J].J Urol,2002,167(3):1334-1337.
[13] Ferroni MC,Lyon TD,Rycyna KJ,et al.The role of prophylactic antibiotics after minimally invasive pyeloplasty with ureteral stent placement in children[J].Urology,2016,89:107-111.DOI:10.1016/j.urology.2015.11.035.
[14] Kim JK,Lee MJ,Gao B,et al.Comparison of continuous and interrupted suture techniques in pyeloplasty:a systematic review and meta-analysis[J].Pediatr Surg Int,2022,38(9):1209-1215.DOI:10.1007/s00383-022-05173-4.
[15] Kong XP,Li ZP,Li MJ,et al.Comparison of drainage methods after pyeloplasty in children:a 14-year study[J].Front Pediatr,2021,9:779614.DOI:10.3389/fped.2021.779614.
[16] Rohrmann D,Snyder HM 3rd,Duckett JW Jr,et al.The operative management of recurrent ureteropelvic junction obstruction[J].J Urol,1997,158(3 Pt 2):1257-1259.DOI:10.1097/00005392-199709000-00154.
[17] Romao RLP,Koyle MA,Pippi Salle JL,et al.Failed pyeloplasty in children:revisiting the unknown[J].Urology,2013,82(5):1145-1147.DOI:10.1016/j.urology.2013.06.049.
[18] Gao WZ,Zhang L,He YH,et al.Analysis of the efficacy and risk factors of surgical treatment of recurrent UPJO in adults[J].Int Urol Nephrol,2023,55(6):1493-1499.DOI:10.1007/s11255-022-03439-3.
[19] Ceyhan E,Ileri F,Ceylan T,et al.Predictors of recurrence and complications in pediatric pyeloplasty[J].Urology,2019,126:187-191.DOI:10.1016/j.urology.2019.01.014.
[20] He YZ,Song HC,Liu P,et al.Primary laparoscopic pyeloplasty in children:a single-center experience of 279 patients and analysis of possible factors affecting complications[J].J Pediatr Urol,2020,16(3):331.e1-331.e11.DOI:10.1016/j.jpurol.2020.03.028.
[21] Braga LHP,Lorenzo AJ,B?gli DJ,et al.Risk factors for recurrent ureteropelvic junction obstruction after open pyeloplasty in a large pediatric cohort[J].J Urol,2008,180(4 Suppl):1684-1688.DOI:10.1016/j.juro.2008.03.086.
[22] Thomas JC,DeMarco RT,Donohoe JM,et al.Management of the failed pyeloplasty:a contemporary review[J].J Urol,2005,174(6):2363-2366.DOI:10.1097/01.ju.0000180420.11915.31.
[23] Duel BP,Vates TS,Heiser D,et al.Antegrade pyelography before pyeloplasty via dorsal lumbar incision[J].J Urol,1999,162(1):174-176.DOI:10.1097/00005392-199907000-00063.
[24] Liu X,Huang CG,Guo Y,et al.Comparison of DJ stented,external stented and stent-less procedures for pediatric pyeloplasty:a network meta-analysis[J].Int J Surg,2019,68:126-133.DOI:10.1016/j.ijsu.2019.07.001.
[25] Chen RL,Jiang C,Li X,et al.Analysis of risk factors for stenosis after laparoscopic pyeloplasty in the treatment of ureteropelvic junction obstruction[J/OL].Int Urol Nephrol:2024.https://doi.org/10.1007/s11255-023-03906-5.DOI:10.1007/s11255-023-03906-5.
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备注/Memo
收稿日期:2024-02-18。
基金项目:国家自然科学基金项目(82371722)
通讯作者:杨屹,Email:yangy2@sj-hospital.org