Zhu Guodong,Liu Xingjian,Li Aiwu.Comparative efficacy analysis of pneumovesical modified nipple versus Cohen ureteral reimplantation for infantile primary obstructed megaureter[J].Journal of Clinical Pediatric Surgery,2026,(04):365-370.[doi:10.3760/cma.j.cn101785-20251030-00028]
气膀胱下改良乳头再植术与Cohen术治疗婴儿原发梗阻性巨输尿管的疗效分析
- Title:
- Comparative efficacy analysis of pneumovesical modified nipple versus Cohen ureteral reimplantation for infantile primary obstructed megaureter
- Keywords:
- Megaloureter; Infant; Laparoscopy; Ureteral Reimplantation; Therapeutic Effect; Retrospective Study
- 摘要:
- 目的 比较气膀胱改良乳头输尿管再植术与气膀胱Cohen输尿管再植术在婴儿原发性梗阻性巨输尿管(primary obstructed megaureter,POM)治疗中的临床效果及安全性。方法 本研究为回顾性队列研究。以2015年1月至2024年10月山东大学附属齐鲁医院收治的56例婴儿POM为研究对象,根据手术方式不同分为改良乳头组(29例)和Cohen组(27例)。比较两组患儿手术时间、术中出血量、术后血尿时间、术后住院时间、并发症发生率及术后超声指标(输尿管直径、肾盂前后径以及肾皮质厚度)。结果 Cohen组中转开放手术2例,改良乳头组无一例中转手术。改良乳头组手术时间[(97.93±12.14)min比(125.59±14.50)min]、术后血尿时间[(2.10±1.08)d比(2.74±1.02)d]、住院时间[(9.45±2.26)d比(12.04±4.47)d]均短于Cohen组,差异均具有统计学意义(P＜0.05);两组术中出血量及住院费用差异无统计学意义(P＞0.05)。随访13个月至9年,改良乳头组输尿管直径[(0.58±0.17)cm比(0.71±0.19)cm]较Cohen组更小,差异具有统计学意义(P＜0.05),其余超声检查指标差异无统计学意义(P＞0.05);改良乳头组2例、Cohen组3例支架管留置期间出现发热性尿路感染,经抗生素治疗后好转,拔管后未再复发;Cohen组术后3个月,行经排尿性膀胱尿道造影(voiding cystourethrography,VCUG)发现1例Ⅰ°输尿管反流,无明显症状,随访1年后反流消退;改良乳头组术后6个月发现1例Ⅱ°反流,不伴临床症状,随访10个月后反流消失。结论 两种输尿管再植术治疗婴儿POM均疗效确切。气膀胱改良乳头输尿管再植术因操作相对简便、创伤小、恢复快,更契合婴儿膀胱的生理特点,是婴儿POM的优选术式。
- Abstract:
- Objective To compare the clinical outcomes and safety of pneumovesical modified nipple ureteral reimplantation versus pneumovesical Cohen ureteral reimplantation for primary obstructed megaureter (POM) in infants.Methods For this retrospective cohort study,the relevant clinical data were retrospectively reviewed for 56 POM infants from January 2015 to October 2024.According to specific surgical approaches,they were assigned into two groups of Cohen (n=27) and modified nipple (n=29).Operative duration,intraoperative volume of blood loss,duration of postoperative hematuria,length of postoperative hospitalization stay,complication rates and postoperative ultrasonic parameters (ureteral diameter,anteroposterior pelvic diameter & renal cortical thickness) were compared between two groups.Results Two cases in Cohen group required intraoperative conversion into open surgery while no conversion occurred in modified nipple group.Operative duration[(97.93±12.14) vs.(125.59±14.50)min],duration of postoperative hematuria[(2.10±1.08) vs.(2.74±1.02)day]and length of hospitalization stay[(9.45±2.26) vs.(12.04±4.47)day]were all significantly shorter in modified nipple group than those in Cohen group (all P<0.05).Intraoperative volume of blood loss and hospitalization expenses did not differ markedly between two groups (P>0.05).Over a follow-up period of 13 months to 9 years,ureteral diameter was smaller in modified nipple group than that in Cohen group[(0.58±0.17) vs.(0.71±0.19)cm,P<0.05]while other ultrasonographic parameters showed no significant between-group differences (P>0.05).Febrile urinary tract infection occurred during stenting in modified nipple group (n=2) and Cohen group (n=3); all improved with antibiotic therapy and did not recur after stent removal.In Cohen group,voiding cystourethrography (VCUG) at 3 months postoperatively revealed grade I vesicoureteral reflux (VUR) without symptoms (n=1).It self-resolved after 1-year follow-up.In modified nipple group,one case of grade Ⅱ VUR was identified at 6 months postoperatively without clinical symptoms disappeared after 10-month follow-up.Conclusions Both ureteral reimplantation techniques are efficacious for infantile POM.Pneumovesical modified nipple ureteral reimplantation,with its relatively simple procedure,minimal trauma and faster recovery,better aligns with the physiological characteristics of infantile bladder,making it a preferred surgical approach for infantile POM.
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备注/Memo
收稿日期:2025-10-30。
基金项目:山东省齐鲁医学院发展基金(34641390220001)
通讯作者:李爱武,Email:liaiwu@qiluhospital.com