Wu Yong,Guan Yong,Wang Xin,et al.Efficacy comparison of laparoscopic Lich-Gregoir technique versus vesicoscopic Politano-Leadbetter technique during ureteral reimplantation for primary vesicoureteral reflux in children[J].Journal of Clinical Pediatric Surgery,2025,(07):628-634.[doi:10.3760/cma.j.cn101785-202503118-006]
腹腔镜Lich-Gregoir术与气膀胱Politano-Leadbetter输尿管再植术治疗儿童原发性膀胱输尿管反流的疗效分析
- Title:
- Efficacy comparison of laparoscopic Lich-Gregoir technique versus vesicoscopic Politano-Leadbetter technique during ureteral reimplantation for primary vesicoureteral reflux in children
- Keywords:
- Vesicoureteral Reflux; Laparoscope; Surgical Procedure; Operative; Child
- 摘要:
- 目的 评价腹腔镜Lich-Gregoir术与气膀胱Politano-Leadbetter术治疗儿童原发性膀胱输尿管反流(vesicoureteral reflux,VUR)临床疗效。方法 本研究为回顾性研究,收集2016年10月至2023年10月于天津市儿童医院接受手术治疗的91例原发性VUR患儿临床资料,依据手术方案的不同分为腹腔镜组(n＝53)和气膀胱组(n＝38),按照单侧或双侧手术进一步分为单侧腹腔镜组(A组,n=26)和双侧腹腔镜组(B组,n=27),以及单侧气膀胱组(C组,n=18)和双侧气膀胱组(D组,n=20);比较各组手术时间、术中出血量、术后血尿时间、留置尿管时间、住院时间及术后随访情况。结果 各组手术均顺利完成,无一例中转开腹手术;A组&C组、B组&D组在性别、年龄、身体质量指数、侧别、反流程度方面比较,差异均无统计学意义(P>0.05)。A组、C组的住院时间分别为(8.28±0.92) d和(8.72±0.67) d,B组、D组的住院时间分别为(8.68±0.85) d和(8.80±1.01) d;A组、C组的术中出血量分别为(6.00±0.98) mL和(6.61±1.15) mL,B组、D组的术中出血量分别为(10.07±1.52) mL和(9.35±2.16) mL;A组、C组留置尿管时间分别为(6.22±0.75) d和(6.61±0.70) d,B组、D组留置尿管时间分别为(7.12±1.38) d和(6.80±1.11) d;上述指标组间比较差异均无统计学意义(P>0.05)。A组、C组手术时间分别为(105.25±16.79) min和(126.11±18.18) min,B组、D组手术时间分别为(150.95±16.64) min和(162.35±19.17) min;A组、C组术后血尿时间分别为(0.17±0.39) d和(2.94±0.64) d,B组、D组术后血尿时间分别为(0.28±0.48) d和(3.90±0.85) d;上述指标差异均有统计学意义(P<0.001)。腹腔镜组与气膀胱组各有4例出现发热性尿路感染(urinary tract infection,UTI),进一步行排泄性膀胱尿道造影(voiding cystourethrography,VCUG)提示,腹腔镜组有3例、气膀胱组有2例存在低级别反流,均于预防性口服抗生素治疗3个月后痊愈;双侧腹腔镜组有1例出现术后急性尿潴留,保留导尿管2周并辅助膀胱功能训练后痊愈。结论 腹腔镜Lich-Gregoir术、气膀胱Politano-Leadbetter术均为治疗原发性VUR的有效方法。腹腔镜Lich-Gregoir术视野开阔、操作简单、手术时间较短。
- Abstract:
- Objective To evaluate the efficacy of laparoscopic Lich-Gregoir technique versus vesicoscopic Politano-Leadbetter technique during ureteral reimplantation for primary vesicoureteral reflux (VUR) in children. Methods A retrospective analysis was conducted for 91 children operated for primary VUR from October 2016 to October 2023.The relevant clinical data were collected.According to different surgical approaches,they were assigned into two groups of laparoscopic (n=53) and vesicoscopic (n=38).And they were further divided into unilateral laparoscopic group (group A) (n=26) and bilateral laparoscopic group (group B) (n=27),as well as unilateral vesicoscopic group (group C) (n=18) and bilateral vesicoscopic group (group D) (n=20).Operative duration,intraoperative volume of blood loss,postoperative hematuria time,indwelling catheterization length and postoperative hospitalization stay were compared among the groups.And the postoperative follow-up status of each group was recorded. Results All operations were successfully completed without any conversion into open surgery.No statistically significant difference existed in gender,age,body mass index (BMI),affected sideness or severity reflux (P>0.05).Average hospitalization stay for groups A and C was (8.28±0.92) and (8.72±0.67) day.Average hospitalization stay for groups B and D was (8.68±0.85) and (8.80±1.01) day.Average intraoperative blood loss in groups A and C was (6.00±0.98) and (6.61±1.15) mL.Average intraoperative blood loss in groups B and D was (10.07±1.52) and (9.35±2.16)mL; Average duration of indwelling urinary catheterization for groups A and C were (6.22±0.75) and (6.61±0.70) day.Average duration of indwelling urinary catheterization for group B and D was (7.12±1.38) and (6.80±1.11) day.Inter-group differences were no statistically significant (P>0.05).Operative duration for groups A and C was (105.25±16.79) and (126.11±18.18) min.Operative duration for groups B and D was (150.95±16.64) and (162.35±19.17) min.Duration of gross hematuria in groups A and C was (0.17±0.39) and (2.94±0.64) day.Duration of gross hematuria in groups B and D was (0.28±0.48) and (3.90±0.85) day.Inter-group differences were statistically significant (P<0.001).Postoperative febrile urinary tract infections (UTIs) developed in eight patients in both laparoscopic and vesicoscopic cohorts (n=4 each).Further voiding cystourethrography indicated that 3 cases in laparoscopic group and 2 cases in vesicoscopic group had low-grade reflux and recovered after 3-month prophylactic oral antibiotics.In bilateral laparoscopic group,1 case of acute postoperative urinary retention recovered after 2-week catheterization and supplemental bladder function training. Conclusions Ureteral reimplantation via laparoscopic Lich-Gregoir and vesicoscopic Politano-Leadbetter techniques are both efficacious for primary VUR.In contrast,laparoscopic Lich-Gregoir approach provides enhanced intraoperative visualization,simplified technical execution,and reduced operative time,collectively supporting its broader implementation in clinical practice.
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备注/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);天津市卫生健康行业高层次人才选拔培养工程青年医学新锐(TJSQNYXXR-D2-069)
通讯作者:关勇,Email:guanyongyisheng@163.com