摘要
目的:探讨小儿先天性肾盂输尿管连接部梗阻性肾积水程度与各指标之间的联系,以期规范临床实践。方法:回顾分析2018年8月至2019年8月为98例先天性肾盂输尿管连接部梗阻性肾积水患儿行腹腔镜离断式肾盂成形术(Anderson-Hynes离断式肾盂成形术)的临床资料。按术前肾积水程度进行分组。轻度:肾脏外形、肾实质厚度(PT)均正常,肾盂前后径(APD)分离1~2 cm;中度:肾脏外形体积增大,PT变薄,肾盂肾盏扩张,APD为2.1~3.5 cm;重度:肾脏体积明显增大,PT变薄或完全萎缩,APD>3.6 cm。轻度13例,中度56例,重度29例。分析各组手术前后APD、PT、手术时间、住院时间、拔管时间等临床指标。结果:各组术后中、重度肾积水患儿病肾APD、PT值与术前相比差异均有统计学意义(P<0.05),但术后轻度肾积水患儿病肾APD、PT值与术前相比差异无统计学意义(P>0.05);Pearson相关性分析显示,手术时间(r=0.559)、住院时间(r=0.720)、拔除腹腔引流管时间(r=0.492)、拔除尿管时间(r=0.713)与术前肾积水程度显著正相关。结论:轻度肾积水应长期随访观察,不必急于手术;中重度肾积水患儿术后疗效显著,且积水程度越重,手术时间、住院时间、拔管时间会越长;应严格掌握手术适应证与禁忌证。
Objective:To explore the relationship between the degree of hydronephrosis and each index,and to standardize clinical practice.Methods:From Aug.2018 to Aug.2019,children with congenital obstructive hydronephrosis at the junction of the pelvis and ureter were admitted,and 98 cases of laparoscopic disconnected pyeloplasty were selected.According to the degree of hydronephrosis before surgery,patients were grouped.Mild hydronephrosis means the appearance of the kidney and the renal parenchyma thickness(PT)are normal,the anterior and posterior diameter(APD)of the renal pelvis is separated to 1-2 cm.Moderate:the appearance and volume of the kidney increases,the PT becomes thinner,the renal pelvis and calyces are dilated,and the APD of the renal pelvis is 2.1-3.5 cm.Severe:the volume of the kidney is obviously increased,the PT is thinned or complete atrophy,and the APD of the renal pelvis is>3.6 cm.There were 13 children with mild hydronephrosis,56 children with moderate hydronephrosis,and 29 children with severe hydronephrosis.The clinical indexes such as APD,PT,operative time,hospital stay,time of removal tube were analyzed in every group.Results:The APD and PT values of diseased kidney in children with moderate and severe hydronephrosis after operation were significantly improved compared with those before operation(P<0.05),but the difference was not statistically significant in children with mild hydronephrosis(P>0.05).The Pearson correlation analysis showed that operation time(r=0.559),hospital stay(r=0.720),the time to remove the abdominal drainage tube(r=0.492)and the time to remove the urinary catheter(r=0.713)was significantly correlated with the degree of preoperative hydronephrosis.Conclusions:Mild hydronephrosis should be followed up for long-term observation,and there is no need to perform surgery immediately;children with moderate to severe hydronephrosis have a significant postoperative curative effect,and the heavier the degree of hydronephrosis,the longer the operation time,hospital stay and removal drainage tube time will be.Surgeons should strictly master the operative indication and contraindication.
作者
王馨
张蕾
WANG Xin;ZHANG Lei(Department of Pediatric Surgery,Qilu Hospital of Shandong University,Jinan 250012,China)
出处
《腹腔镜外科杂志》
2021年第3期223-226,240,共5页
Journal of Laparoscopic Surgery
