Wang Hao,Gui Meng,He Qingbao,et al.Clinical outcomes of pneumovesicoscopic ureteral reimplantation for ureterovesical junction obstruction in young infants aged under 6 months[J].Journal of Clinical Pediatric Surgery,2026,(04):371-376.[doi:10.3760/cma.j.cn101785-20251124-00085]
气膀胱输尿管膀胱再植术治疗6月龄以下婴儿膀胱输尿管连接处梗阻的疗效与安全性分析
- Title:
- Clinical outcomes of pneumovesicoscopic ureteral reimplantation for ureterovesical junction obstruction in young infants aged under 6 months
- 关键词:
- 输尿管梗阻; 膀胱输尿管连接处梗阻; 婴儿; 微创外科手术; 气膀胱输尿管膀胱再植术
- Keywords:
- Ureteral Obstruction; Ureterovesical Junction Obstruction; Infant; Mini-invasive Surgical Procedures; Pneumovesicoscopic Ureteral Reimplantation
- 摘要:
- 目的 探讨气膀胱输尿管膀胱再植术治疗6月龄以下婴儿膀胱输尿管连接处梗阻(ureterovesical junction obstruction,UVJO)的疗效与安全性。方法 采用单中心回顾性队列研究方法,收集2019年1月至2023年12月山东大学附属儿童医院收治的77例UVJO患儿临床资料,分为小月龄组(<6个月,19例)和年长儿组(≥6个月,58例)。小月龄组均符合严格高危手术指征(≥2项高危特征)。比较两组患儿围手术期指标、术后并发症及疗效情况。结果 患儿均顺利完成手术。小月龄组术中CO2气体泄漏发生率高于年长儿组(36.8%比13.8%),差异具有统计学意义(P=0.028),两组漏气患儿均经加置穿刺套管针排气后顺利完成手术。两组术后并发症发生率差异无统计学意义(10.5%比8.6%,P=0.675)。两组随访(19.4±8.2)个月,所有患儿肾盂前后径(anteroposterior diameter,APD)和输尿管直径均较术前显著缩小,小月龄组APD从(21.21±10.93)mm缩小至(8.95±4.21)mm,输尿管直径从(17.79±5.16)mm缩小至(7.42±2.68)mm(P<0.001);年长儿组APD从(26.90±11.29)mm缩小至(10.31±5.17)mm,输尿管直径从(17.03±4.93)mm缩小至(7.86±3.04)mm,两组差异无统计学意义(P>0.05)。两组术后影像学改善率为96.1%。结论 针对符合严格高危指征的6月龄以下UVJO患儿,由有经验的术者实施气膀胱输尿管膀胱再植术安全可行,患儿围手术期安全性和中期影像学改善率与≥6月龄患儿相当,为6月龄以下UVJO患儿的早期手术干预提供了初步影像学证据。
- Abstract:
- Objective To evaluate the safety and efficacy of pneumovesicoscopic ureteral reimplantation for ureterovesical junction obstruction (UVJO,also known as primary nonrefluxing megaureter) in young infants aged <6 month.Methods A single-center retrospective cohort study was conducted for 77 UVJO children from January 2019 to December 2023.They were assigned into two groups of young infant (<6 month,n=19) and older infant (≥6 month,n=58).The subjects were strictly selected according to predefined high-risk surgical criteria[≥2 of the following: ureteral diameter ≥7 mm with anteroposterior diameter (APD) ≥15 mm,recurrent febrile urinary tract infections ≥2 episodes,radiologic progression >20% within 3-6 months,failure of conservative management for ≥3 month or renal cortical thinning <3 mm/differential renal function <40%].Perioperative parameters,complications and follow-up outcomes were compared.Results All surgical procedures were completed successfully.Intraoperative gas leakage was higher in young infants (36.8% vs.13.8%,P=0.028).However,it was managed by additional Trocar placement.Complication rates were similar (10.5% vs. 8.6%,P=0.675).During a follow-up period of 19.4±8.2 month,both groups demonstrated significant improvements in renal pelvis diameter and ureteral diameter (P<0.001).In the young infant group,APD declined from (21.21±10.93) to (8.95±4.21) mm while ureteral diameter dropped from (17.79±5.16) to (7.42±2.68) mm.Overall radiographic improvement rate,based upon predefined ultrasound criteria,was 96.1%(74/77).Three children (3.9%) experienced recurrent urinary tract infections during follow-up. Conclusions Under strict indications and experienced surgeons,pneumovesicoscopic ureteral reimplantation for UVJO is both safe and feasible for young high-risk infants.Their perioperative safety and medium-term radiographic outcomes are comparable to older children.This study provides preliminary radiographic rationales for early surgical interventions in selected young high-risk infants.Further studies with functional endpoints are required for validating long-term renal outcomes.
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备注/Memo
收稿日期:2025-11-24。
通讯作者:张磊,Email:zhangyiyuok@126.com