目的 比较先天性肾盂输尿管连接部梗阻(UPJO)手术后不同引流方式的效果及优缺点,探讨UPJO手术后的引流选择。 方法 回顾性分析经本院手术治疗的62例UPJO导致肾积水患儿临床资料,按照术中放置引流管的方式分为两组:36例为内引流组(双J管),26例为外引流组(肾盂引流管、输尿管支架管、肾周引流管)。两组在性别、年龄、侧别上进行比较,差异无统计学意义(P>0.05)。比较两组手术时间、术中出血量和术后并发症情况,随访肾积水恢复情况。 结果 62例均手术成功,均经术后病理检查证实为肾盂输尿管连接部梗阻。内引流组与外引流组手术时间分别为(75.83±12.50)min和(93.46±19.17)min, 差异有统计学意义(t=4.381,P<0.05); 内引流组出血量为(11.89±8.26)mL,外引流组为(15.15±13.86)mL,差异无统计学意义(t=1.159,P>0.05); 外引流组泌尿系感染的发生率为11.5%,内引流组无一例发生感染,差异有统计学意义(x2=4.365,P<0.05); 内引流组术后反流率为8.3%,外引流组无一例发生反流,差异无统计学意义(x2=2.277,P=0.131); 内引流组、外引流组狭窄的发生率分别为5.6%和7.7%,差异无统计学意义(x2=0.114,P>0.05)。血尿持续时间在内引流组和外引流组分别为(2.67±2.04)d和(2.65±1.77)d,差异均无统计学意义(t=-0.026,P>0.05)。 结论 UPJO手术后留置双J管内引流与传统外引流方式相比,缩短了手术时间,术后并发症少,术后恢复快,值得临床推广。
Objective To evaluate the advantages and disadvantages of urine drainage for congenital hydronephrosis. Methods The clinical data were retrospectively analyzed for 62 surgical cases of hydronephrosis.According to urine drainage,they were divided into two groups of internal(n=36,double-J)and external drainage(n=26,renal pelvis,ureteral stent,perinephric drainage tube).All cases were confirmed by postoperative pathology as ureteropelvic junction stricture.Two groups were compared with regards to operative duration,volume of blood loss,incidence of complications and postoperative hydronephrotic recovery. Results All operations were successful.No significant inter-group differences existed in gender,age or incidence of side effects(P>0.05).There was statistically significant inter-group difference in operative duration(P<0.05).Operative duration of double-J tube group was shorter than that of nephrostomic ureteral stent group.The volume of bleeding during internal drainage was less than that during external drainage [(11.89±8.26)vs(15.15±13.86)mL].And the difference was not statistically significant(P>0.05).The incidence of urinary infection was remarkably lower in double-J tube group than that in nephrostomic ureteral stent group(0 vs 11.5%,P<0.05); with regards to the rates of postoperative reflux,stricture and postoperative hematuria duration,differences were not statistically significant(P>0.05). Conclusion Compared with traditional external drainage,double J tube postoperative drainage of UPJO can shorten operative duration,reduce postoperative complications and recover faster.It is worthy of wider clinical popularization.
