无支架离断式肾盂输尿管成形术在婴幼儿肾盂输尿管连接部梗阻中的应用

摘要

目的 探讨无支架离断式肾盂输尿管成形术在婴幼儿肾盂输尿管连接部梗阻(UPJO)的应用. 方法 对2006-2015年单中心收治的486例UPJ成形的婴幼儿进行规律随访和回顾分析,根据支架放置方式分组,47例未放置支架管,为无支架组,该组又分为A(n=34,放置肾周引流)及B(n=13,未放置肾周引流)两个亚组,251例内置双J管1条,为内支架组,188例放置外支架管和肾造瘘各一条,为外支架组,比较各组术前、术中、术后近期及远期疗效的差别. 结果 无支架组平均手术时间(83.5 ±26.5 min)短于内支架组(102±36.5 min,P=0.011)及外支架组(114 ±48.5min,P=0.009).A组腹部并发症、发热、尿路感染、肾周积液发生率均低于B组(P＜0.05).无支架组尿漏率(6/47)高于内支架组(6/251,P=0.005)及外支架组(5/188,P=0.010),三组术后早期尿路感染、腹部并发症、切口感染和肾穿刺造瘘率比较差别无统计学意义(P＞ 0.05).无支架组术后平均住院时间(6.3 d)短于外支架组(10.6d,P=0.008).随访1年后,无支架组17例肾积水转为轻度或消失,远期成功率为93.6％,肾皮质厚度、GFR较术前增加(P＜0.05);无支架组出院后尿路感染率(0/47)明显低于内支架组(68/235,P＜0.001),三组吻合口梗阻及再手术率比较差别无统计学意义(P＞0.05). 结论 无支架离断式UPJ成形术在婴幼儿的应用是可行的,远期随访效果好,大大降低了尿路感染的发生率,但明显增加了尿漏风险,肾周引流及精细确切的吻合技术是该术式成功的关键.%Objective To evaluate the application of stentless dismembered pyeloplasty in ureteropelvic junction obstruction (UPJO) infants.Methods A total of 486 UPJO infants undergoing dismembered pyeloplasty at a single center during 2006 to 2015 were reviewed.Then 47 stentless cases were divided into subgroup A(n =34,with perirenal drainage) and B (n =13,without perirenal drainage).And 251 cases with double J stent were assigned into INS group while 188 cases with external urethral stent EXS group.The relevant clinical data were collected and analyzed for each group.Results Operative duration of stentless group was shorter than that of INS group (83.5-±26.5 vs 102 ±36.5 min,P =0.011) and EXS group (114 ±48.5,P =0.009) Abdominal complications,fever,urinary tract infection (UTI) and perirenal effusion rate of subgroup A was lower than those of subgroup B (P ＜ 0.05).Leakage rate of stentless group (6/47) was higher than INS (6/251,P =0.005) and EXS groups (5/188,P =0.010).Early postoperative UTI,abdominal complications,wound infections and nephrostomy rate had no statistically significant differences among 3 groups.Postoperative length-of-stay of stentless group was shorter than that of EXS group (6.3 vs 10.6 days,P =0.02).Mtera follow-up period of 12 months,17 cases of hydronephrosis in stentless group became alleviated or disappeared and acquired a success rate of 93.6％,renal cortex thickness and glomerular filtration rate (0.86 ± 0.32 cm,38.8 ± 15.5 ml/min) increased as compared with preoperative levels (0.46 ±-0.24cm,P ＜0.01;32.0 ± 16.8 ml/min,P ＜0.01).Post-discharged UTI rate of stentless group was lower than that of INS group (0/47 vs 68/235,P ＜0.001).Conclusions For UPJO infants,stentless dismembered pyeloplasty may achieve excellent long-term efficacies with lower UTI rate and treatment costs.However,there is a higher leakage risk.And perirenal drainage and precise suturing are vital for operative success.