Yan Bing,Zhanghuang Chenghao,Tang Haoyu,et al.Analysis of curative efficacy for open small incision Anderson-Hynes treatment of children with hydronephrosis: a report of 83 cases[J].Journal of Clinical Pediatric Surgery,2020,19(05):432-436.[doi:10.3969/j.issn.1671-6353.2020.05.011]
开放小切口Anderson-hynes术治疗小儿肾积水83例疗效分析
- Title:
- Analysis of curative efficacy for open small incision Anderson-Hynes treatment of children with hydronephrosis: a report of 83 cases
- 关键词:
- 肾积水; Anderson-hynes术; 治疗; 儿童
- Keywords:
- Hydronephrosis; Anderson-Hynes; Treatment; Child
- 分类号:
- R726.9;R692.2
- 摘要:
- 目的 探讨开放小切口Anderson-hynes术治疗小儿肾盂输尿管连接部狭窄（ureteropelvic junction obstruction，UPJO）所致肾积水的有效性及临床应用价值。方法 回顾性分析2016年7月至2017年6月昆明市儿童医院泌尿外科因肾积水行开放性Anderson-hynes术患儿的临床资料，结合国内外最新Anderson-hynes术相关文献报道，从手术时间、术中出血量、住院天数、术后并发症发生情况等方面评价其疗效。结果 本研究共纳入83例患儿，年龄31日龄至8岁，平均（2.1±1.9）岁；左侧47例，右侧28例，双侧8例；因积水加重行二次手术3例，取管后反复尿路感染3例，取管后积水未减轻1例；手术时间45~165 min，平均（95.2±26.5）min；术中出血量2~15 mL，平均（6.9±3.5）mL；住院天数5~28 d，平均（12.2±4.2）d。5例因尿外渗及输尿管长段狭窄而延迟至术后3个月取出双J管，其余患儿均于术后1个月取管，无一例发生管位回缩及结石形成；随访6个月至3年。术前肾盂前后径（anterior and posterior diameter of renal pelvis，APD）较术后缩短[（44.2±18.4）mm vs.（16.1±9.6）mm，P<0.001]；术后最小肾皮质厚度较术前增厚[（9.3±1.4）mm vs.（4.2±2.0）mm，P<0.001]，患儿均成功解除梗阻，临床症状消失。结论 开放小切口Anderson-hynes术疗效确切，学习曲线短，硬件设施要求低，在不具备腹腔镜设备的二级和三级医院值得推广。
- Abstract:
- Objective To explore the effectiveness and necessity of pyeloureteroplasty for ureteropelvic junction obstruction in infants and toddlers.Methods The clinical data were retrospectively reviewed for 83 children undergoing open Anderson-Hynes procedure for hydronephrosis from July 2016 to June 2017.In conjunctions with the recent domestic and international literatures,the curative efficacy was evaluated from the perspectives of operative duration,amount of intraoperative hemorrhage,days of hospitalization and occurrences of postoperative complications.Results The average age was (2.1±1.9)years.The involved side was left (n=47),right (n=28) and bilateral (n=8).There were re-operation for aggravated hydrops (n=3),recurrent urinary tract infection (n=3) and non-relief of hydronephrosis after extraction (n=1).The average operative duration was (45-165)(95.2±26.5) min,the average volume of blood loss (2-15)(6.9±3.5) ml and the hospitalization duration (5-28)(12.2±4.2) days.Removing double-J tube was delayed until 3 months due to urinary extravasation and long-segment ureteral obstruction of ureter (n=5).For the remainder,removal occurred at 1 month post-operation.No tube retraction or stone occurred during a mean follow-up period of 1.7(0.5-3) years.The anterior and posterior diameter of renal pelvis decreased postoperatively[(44.2±18.4) versus (16.1±9.6) mm,P<0.001].And the postoperative renal cortical thickness was greater than the preoperative counterpart[(9.3±1.4) versus (4.2±2.0) mm,P<0.001].All obstructions were successfully relieved.The symptoms were alleviated and the clinical symptoms disappeared.Conclusion With a short learning curve,open small incision Anderson-hynes procedure is effective.Its requirement of hardware facilities is low so that it is worth wider popularization at secondary and tertiary hospitals without laparoscopic equipment.
参考文献/References:
1 杨艳芳.小儿先天性肾盂输尿管连接部梗阻126例[J].临床小儿外科杂志,2007,6(3):37-38.DOI:10.3969/j.issn.1671-6353.2007.03.016. Yang YF.Congenital ureteropelvic junction obstruction in children:a report of 126 cases[J].J Clin Ped Sur,2007,6(3):37-38.DOI:10.3969/j.issn.1671-6353.2007.03.016.
2 Esmaeili M,Esmaeili M,Ghane F,et al.Comparison between diuretic urography(IVP)and diuretic renography for diagnosis of ureteropelvic junction obstruction in children[J].Iran J Pediatr,2016,26(1):e4293.DOI:10.5812/ijp.4293.
3 黄澄如.肾盂输尿管连接部梗阻[M].小儿泌尿外科学,济南:山东科学技术出版社,1996:86-101. Huang CR.Obstruction of renal pelvis and ureter junction[M].Pediatric Urology.Jinan:Shandong Science and Technology Press,1996:86-101.
4 Peters CA,Schlussel RN,Retik AB.Pediatric laparoscopic dismembered pyeloplasty[J].J Urol,1995,153:1962-1965.DOI:10.1016/S0022-5347(01)67378-6.
5 Mikolaj,Mendrek,Thomas,et al.Recent advances in urologic surgical techniques for pyeloplasty[J].F1000Res,2019,8(15):1-6.DOI:10.12688/f1000research.15866.1.
6 韩文文,张潍平,孙宁,等.小儿腹腔镜离断性肾盂成形术学习曲线分析[J].继续医学教育,2017,31(8):13-15.DOI:10.3969/j.issn.1004-6763.2017.08.007. Han WW,Zhang WP,Sun N,et al.Analysis of learning curve of laparoscopic pyeloplasty in children[J].Continuing Education,2017,31(8):13-15.DOI:10.3969/j.issn.1004-6763.2017.08.007.
7 李燕,张蕾,谭国华.腹腔镜肾盂成形术治疗婴幼儿肾盂输尿管连接部梗阻性肾积水疗效观察[J].山东医药,2013,53(37):77-79.DOI:10.3969/j.issn.1002-266X.2013.37.030. Li Y,Zhang L,Tan GH.Efficacy of laparoscopic pyeloplasty for obstructive hydronephrosis in ureteropelvic junction obstruction of infants and toddlers[J].Shandong Medicine,2013,53(37):77-79.DOI:10.3969/j.issn.1002-266X.2013.37.030.
8 王晓晖,张书峰,鲍俊涛,等.腹腔镜辅助与小切口肾盂成形术治疗婴儿期先天性肾积水临床疗效比较[J].中华实用诊断与治疗杂志,2016,30(10):984-986.DOI:10.13507/j.issn.1674-3474.2016.10.017. Wang XH,Zhang SF,Bao JT,et al.Clinical comparison of laparoscopic assisted versus small incision pyeloplasty for congenital hydronephrosis in infants[J].Chinese Journal of Practical Diagnosis and Treatment,2016,30(10):984-986.DOI:10.13507/j.issn.1674-3474.2016.10.017.
9 Sharifiaghdas F,Mirzaei M,Daneshpajooh A,et al.Minimally invasive open dismembered pyeloplasty technique:Miniature incision,muscle-splitting dissection and no pelvis reduction in children[J].Asian J Urol,2019,6(3):290-293.DOI:10.1016/j.ajur.2018.08.001.
10 Masieri L,Sforza S,Cini C,et al.Minilaparoscopic versus open pyeloplasty in children less than 1 year[J].J Laparoendosc Adv Surg Tech A,2019,29(7):970-975.DOI:10.1089/lap.2018.0586.
11 葛文安,王盛兴,郭涛,等.腹腔镜肾盂成形术与传统肾盂成形术治疗小儿肾积水疗效对比研究[J].陕西医学杂志,2019,48(5):584-587.DOI:CNKI:SUN:SXYZ.0.2019-05-012. Ge WA,Wang SX,Guo T,et al.Comparative study of laparoscopic pyeloplasty versus traditional pyeloplasty for pediatric hydronephrosis[J].Shanxi Journal of Medicine,2019,48(5):584-587.DOI:CNKI:SUN:SXYZ.0.2019-05-012.
12 张一帆,郝春生,任玉乾.腹腔镜下Anderson-Hynes肾盂输尿管成形术治疗6个月以下婴儿肾盂输尿管连接部梗阻[J].中国微创外科杂志,2019,19(7):587-591.DOI:10.3969/j.issn.1009-6604.2019.07.004. Zhang YF,Hao CS,Ren YQ.Laparoscopic Anderson-Hynes pyeloureteroplasty for ureteropelvic junction obstruction in infants aged under 6 months[J].Chin J Min Inv Surg,2019,19(7):587-591.DOI:10.3969/j.issn.1009-6604.2019.07.004.
13 Zamfir Snykers C,De Plaen E,Vermersch S,et al.Is laparoscopic pyeloplasty for ureteropelvic junction obstruction in infants under 1 year of age a good option?[J].Front Pediatr,2019,7:352.DOI:10.3389/fped.2019.00352.
14 Esposito C,Masieri L,Castagnetti M,et al.Robot-assisted vs laparoscopic pyeloplasty in children with uretero-pelvic junction obstruction (UPJO):technical considerations and results[J].J Pediatr Urol,2019,15(6):667.e1-667.e8.DOI:10.1016/j.jpurol.2019.09.018.
15 Storm DW,Braga LH,Cooper CS.Continuous antibiotic prophylaxis in pediatric urology[J].Urol Clin North Am,2018,45(4):525-538.DOI:10.1016/j.ucl.2018.06.001.
相似文献/References:
[1]杨洋 张潍平 彭芸 温洋 杨吉刚.两种输尿管不全梗阻肾积水动物模型制作方法的比较[J].临床小儿外科杂志,2011,10(02):107.
Comparison of two different methods to establish animal model of hydronephrosis due to incomplete ureteral obstruction.[J].Journal of Clinical Pediatric Surgery,2011,10(05):107.
[2]杨星海,杨小红,丁峰,等.肾积水的产前诊断及预后分析[J].临床小儿外科杂志,2008,7(05):1.
[3]谢向辉,黄澄如,孙宁,等.小儿先天性肾盂输尿管连接部梗阻诊治265例[J].临床小儿外科杂志,2008,7(06):13.
[4]张丽瑜,夏慧敏,余家康,等.维甲酸导致胎鼠肾积水的实验研究[J].临床小儿外科杂志,2007,6(02):4.
[5]刘 芳 杨文忠 袁先宏 杨星海.产前ＭＲＩ在评估胎儿中重度肾积水中的作用探讨[J].临床小儿外科杂志,2018,17(01):23.
Liu Fang,Yang Wenzhong,Yuan Xianhong,et al.The role of prenatal MRI in evaluating fetal moderatetosevere hydro nephrosis.[J].Journal of Clinical Pediatric Surgery,2018,17(05):23.
[6]张君颀,耿红全.肾积水患儿的肾功能评估与结局预判[J].临床小儿外科杂志,2020,19(03):193.[doi:10.3969/j.issn.1671-6353.2020.03.001]
Zhang Junqi,Geng Hongquan.Recent advances in renal function evaluation and outcome prediction of pediatric hydronephrosis[J].Journal of Clinical Pediatric Surgery,2020,19(05):193.[doi:10.3969/j.issn.1671-6353.2020.03.001]
[7]马睿.儿童肾积水的影像学诊断策略[J].临床小儿外科杂志,2020,19(03):199.[doi:10.3969/j.issn.1671-6353.2020.03.002]
Ma Rui.Imaging-based diagnostic strategies of pediatric hydronephrosis[J].Journal of Clinical Pediatric Surgery,2020,19(05):199.[doi:10.3969/j.issn.1671-6353.2020.03.002]
[8]马立飞,周辉霞,周晓光,等.吲哚菁绿荧光实时显影技术在儿童复杂肾积水机器人辅助腹腔镜手术中的初步应用[J].临床小儿外科杂志,2021,20(10):921.[doi:10.12260/lcxewkzz.2021.10.005]
Ma Lifei,Zhou Huixia,Zhou Xiaoguang,et al.Applications of indocyanine green and near-infrared fluorescence during complex robot-assisted laparoscopic pyeloplasty[J].Journal of Clinical Pediatric Surgery,2021,20(05):921.[doi:10.12260/lcxewkzz.2021.10.005]
备注/Memo
收稿日期:2019-11-16。
基金项目:云南省教育厅科学研究基金（编号：2020J0228）
通讯作者:张黄成昊,Email:736564145@qq.com