摘要
目的探讨腹腔镜肾折叠术在儿童极重度肾积水中的应用价值。方法收集2015年7月至2020年7月收治的15例极重度肾积水患儿的相关资料。其中,男12例,女3例;平均年龄为5.1岁,年龄范围为7个月至8岁;患侧为左侧10例,右侧5例。将患儿按照随机数字表法分为两个治疗组,A组8例,采取的手术方式为腹腔镜肾盂成形术,B组7例,采取的手术方式为腹腔镜肾盂成形术联合肾皮质折叠缝合术。所有患儿的肾盂分离距离均>40 mm,术前检查提示肾盂输尿管连接部梗阻致肾积水,其中1例合并肾外伤。结果所有患儿术后均留置输尿管内支架管、肾周引流管和导尿管。观察术后患儿恢复情况,了解其尿路感染、肾功能恢复情况和肾脏形态恢复情况。所有患儿手术过程顺利,手术时间范围为110~195 min,术后2~3 d拔出肾周引流管,7~10 d拔出导尿管,6~8周拔出输尿管内支架管。A组患儿中5例术后出现反复尿路感染;5例中的2例经抗感染治疗痊愈,肾脏体积较大;5例中的3例行肾造瘘术,术后1例感染治愈后行顺行肾脏输尿管造影检查提示肾脏排泄基本通畅,拔出造瘘管后恢复顺利,但肾脏形态较大,另2例经顺行肾脏输尿管造影检查提示肾脏容积较大,排泄缓慢,夹闭肾造瘘管后患侧腰部疼痛,提示局部梗阻,再次行腹腔镜肾盂成形并肾脏折叠术,术后恢复顺利,术后未再出现反复尿路感染。B组患儿中的3例在留置内支架管期间出现暂时性的尿路感染,经拔出支架管并积极抗感染后治愈。所有患儿复查核素肾动态显像显示分肾功能较前好转,肾小球滤过率提高,排泄曲线有下降段,B组患儿肾小球滤过率恢复程度较好于A组,彩色多普勒超声检查提示在肾脏形态及肾皮质厚度方面,B组优于A组。结论腹腔镜肾折叠术联合肾盂成形术适用于儿童极重度肾积水肾脏形态和功能的修复,有助于肾内尿液的排空和尿路感染的控制,肾脏形态恢复好,极重度肾积水合并肾皮质较薄时,肾折叠术安全有效。
Objective To explore the values of laparoscopic renal plication for extremely severe hydronephrosis in children.Methods From July 2015 to July 2020,the relevant clinical data were collected from 15 hospitalized children with extremely severe hydronephrosis.There were 12 boys and 3 girls with a mean age of 5.1(7/12-8)years.The involved side was left(n=10)and right(n=5).They were randomly divided into group A(n=8)undergoing laparoscopic pyeloplasty and group B(n=7)with laparoscopic pyeloplasty plus renal cortical plication and suturing.Separation distance of renal pelvis was>40 mm and preoperative examination revealed hydronephrosis due to ureteropelvic junction obstruction from renal trauma(n=1).Results Ureteral stent,perirenal drain and urinary catheter were inserted postoperatively.The recovery of urinary tract infection and renal function/morphology were tracked.All operations went smoothly and operative duration lasted from 110 to 195 min.Perirenal drainage tube was removed at 2 to 3 days,urinary catheter 7 to 10 days and ureteral stent 6 to 8 weeks postoperatively.In group A,2/5 cases of recurrent urinary tract infection were cured by anti-infective regimens and kidney volume remained large;3/5 cases underwent nephrostomy.One infected case was cured and antegrade nephroureterography revealed that renal excretion was basically unobstructed,recovery was smooth after removing gastrostomy tube and yet renal morphology remained large while another 2 cases of local obstruction had large renal volume,slow excretion and lumbar pain at the affected side after clamping nephrostomy tube.Laparoscopic pyeloplasty and nephroplication were re-performed and postoperative recovery was smooth without recurrent urinary tract infection.Transient urinary tract infection occurred during stenting in group B and it was cured by removing stent tube and aggressive anti-infection.Radionuclide renal dynamic imaging indicated that renal function improved,glomerular filtration rate increased and excretion curve decclined.The recovery degree of glomerular filtration rate was better in group B than that in group A.Color Doppler ultrasonography hinted that group B was superior to group A in terms of renal morphology and cortical thickness.Conclusions Indicated for correcting renal morphology and function in children with extremely severe hydronephrosis,laparoscopic renal plication plus pyeloplasty facilitates emptying of intrarenal urine and control of urinary tract infection.Renal morphology recovers well.For extremely severe hydronephrosis with thin renal cortex,renal plication is both safe and effective.
作者
李骥
张谦
郭立华
王磊
孙权
刘艳飞
王冰蕊
崔展阁
Li Ji;Zhang Qian;Guo Lihua;Wang Lei;Sun Quan;Liu Yanfei;Wang Bingrui;Cui Zhange(Department of Pediatric Surgery,First Affiliated Hospital,Zhengzhou University,Zhengzhou 450052,China)
出处
《中华小儿外科杂志》
CSCD
北大核心
2021年第7期629-633,共5页
Chinese Journal of Pediatric Surgery
关键词
儿童
肾积水
腹腔镜
肾折叠
Child
Hydronephrosis
Laparoscopes
Renal folding
