Ruan Shuai,Zhou Jinhan,Li Nianwang,et al.Clinical efficacy of modified small incision retroperitoneal laparoscopy for ureteropelvic junction obstruction in children based upon computed tomography urological imaging precise positioning[J].Journal of Clinical Pediatric Surgery,2022,21(12):1153-1158.[doi:10.3760/cma.j.cn101785-202211010-010]
基于CT尿路成像定位的后腹腔镜改良小切口手术治疗儿童肾盂输尿管连接部梗阻
- Title:
- Clinical efficacy of modified small incision retroperitoneal laparoscopy for ureteropelvic junction obstruction in children based upon computed tomography urological imaging precise positioning
- 关键词:
- 肾盂输尿管连接部梗阻; 腹腔镜; 泌尿外科手术; 手术后并发症; 治疗结果
- Keywords:
- Ureteropelvic Junction Obstruction; Laparoscopes; Urologic Surgical Procedures; Postoperative Complications; Treatment Outcome
- 摘要:
- 目的 探讨术前CT尿路成像(CTU)精准定位下后腹腔镜改良小切口手术治疗儿童肾盂输尿管连接部梗阻(ureteropelvic junction obstruction,UPJO)的临床疗效。方法 回顾性收集湖南师范大学附属第一医院(湖南省人民医院)泌尿外科2016年1月1日至2021年12月31日经影像学检查确诊为UPJO的患儿60例作为研究对象,前期采取传统后腹腔镜手术治疗的患儿(设为对照组)及后期采取CTU精准定位下后腹腔镜改良小切口手术治疗的患儿(设为观察组)各30例。比较两组患儿手术切口长度、手术时间、术中出血量、术后引流管留置时间及术后住院时间;分析两组患儿术后漏尿、伤口感染、泌尿系感染等并发症发生情况;术后随访6~12个月,通过影像学检查评估肾积水复发率。结果 60例均痊愈出院。观察组与对照组比较,手术切口长度分别为(3.28±0.60)cm、(3.82±0.84)cm,差异有统计学意义(P＜0.05);术中出血量分别为(17.50±5.83)mL、(22.00±14.17)mL,差异无统计学意义(P＞0.05);手术时间分别为(82.33±16.12)min、(132.00±30.75)min,差异有统计学意义(P＜0.05);术后腹膜后引流管留置时间分别为(4.60±2.37)d、(7.33±2.37)d,差异有统计学意义(P＜0.05);术后住院时间分别为(6.47±2.06)d、(8.30±2.12)d,差异有统计学意义(P＜0.05)。观察组术后出现漏尿2例,无一例伤口感染、泌尿系感染及其他并发症发生;对照组术后出现漏尿4例、伤口感染1例、泌尿系感染1例,两组差异无统计学意义(P＞0.05)。观察组和对照组术后复发人数分别为1例、2例,差异无统计学意义(P＞0.05)。结论 两种后腹腔镜手术治疗儿童UPJO均疗效确切,但CTU精准定位下后腹腔镜改良小切口手术时间更短,切口更小,术后恢复更快,住院时间更短;远期疗效还需进一步的临床研究来证实。
- Abstract:
- Objective To explore the clinical efficacy of modified small incision retroperitoneal laparoscopy under precise positioning of computed tomography urological imaging (CTU) for ureteropelvic junction obstruction (UPJO) in children.Methods From January 1,2016 to December 31,2021,retrospective review was conducted for clinical data of 60 children diagnosed as UPJO by imaging examination.Thirty children underwent traditional retroperitoneal laparoscopy in an early stage (control group) while another 30 children had modified small incision retroperitoneal laparoscopy under precise positioning of CTU (observation group).Two groups were compared with regards to surgical incision length,operative duration,intraoperative hemorrhage,tube indwelling time of postoperative retroperitoneal drainage and postoperative hospitalization time.And the complications of postoperative leakage,wound infection and urinary tract infection were recorded.During a follow-up period of (6-12) months,imaging examinations were performed for evaluating the recurrence rate of hydronephrosis.Results All of them recovered well and were discharged.Compared with control group,length of surgical incision was (3.28±0.60) and (3.82±0.84) cm and the differences were statistically significant (P<0.05);intraoperative hemorrhagic volume (17.50±5.83) and (22.00±14.17) ml.The difference had no statistical significance (P>0.05);operative duration (82.33±16.12) and (132.00±30.75) min and the difference was statistically significant (P<0.05);tube indwelling time of postoperative retroperitoneal drainage (4.60±2.37) and (7.33±2.37) days.The difference was statistically significant (P<0.05);postoperative hospitalization time (6.47±2.06) and (8.30±2.12) days and the difference was statistically significant (P<0.05).There were leakage (n=2) in observation group and leakage (n=4),wound infection (n=1) and urinary tract infection (n=2) in control group.The difference was not statistically significant (P>0.05).There were 1 and 2 current cases in observation and control groups and the difference was statistically significant (P>0.05).Conclusion Two different surgical approaches have a definite clinical efficacy.Modified small incision retroperitoneal laparoscopy based upon CTU precise positioning offers the advantages of shorter operative duration,faster postoperative recovery,shorter incision length and less hospitalization time.However,long-term efficacy requires further clinical trials.
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备注/Memo
收稿日期:2022-11-5。
基金项目:湖南省卫生健康委科研课题(20200256)
通讯作者:郭玺,Email:393913230@qq.com