摘要
目的 探讨不同手术时机对儿童肾盂输尿管连接处梗阻伴感染的围手术期基本情况及并发症、手术效果的影响。方法 采用回顾性队列研究设计,收集2010年1月至2020年12月重庆医科大学附属儿童医院泌尿外科收治的46例肾盂输尿管连接处梗阻伴感染患儿的病例资料,按照感染控制后距手术时间分为早期手术组(≤1周,n=30)和延迟手术组(≥2个月,n=16),比较两组围手术期基本情况(手术时间、术中出血量、术后住院时间)及并发症(发热、腰痛、腹胀、血尿、高血压、尿外渗、尿路感染)、手术效果(术后6个月肾积水程度、肾皮质改变、再手术)等差异。结果 早期手术组和延迟手术组围手术期基本情况及并发症、再手术情况差异均无统计学意义。两组术后肾积水程度均较术前显著改善(P<0.001);延迟手术组改善水平略优于早期手术组,但差异无统计学意义(P=0.183)。早期手术组术后肾实质厚度改善28例(93.3%),延迟手术组10例(62.5%),两组差异有统计学意义(P=0.026)。结论 儿童肾盂输尿管连接处梗阻伴感染早期或延迟行肾盂输尿管成形术对围手术期基本情况、并发症及再手术无显著影响;延迟手术肾积水程度改善略优于早期手术,但肾实质厚度改善却明显不及早期手术,提示早期手术解除梗阻有利于肾实质恢复,可避免进一步肾损伤。
Objective To investigate the effects of different surgical timing on perioperative basic conditions and complications and surgical outcomes in children suffering from ureteropelvic junction obstruction(UPJO) complicated with upper urinary tract infection. Methods A retrospective cohort study was adopted. Then clinical data of 46 UPJO children with upper urinary tract infection treated in our hospital from January 2010 to December 2020. According to the time from infection controlled to operation, they were divided into early operation group(≤1 week, n=30) and delayed operation group(≥2 months, n=16). The perioperative basic conditions(operation time, intraoperative bleeding volume, and postoperative stay) and complications(fever, lumbago, bloating, hematuria, hypertension, urinary extravasation, and urinary tract infection) and surgical outcomes(hydronephrosis, renal cortical changes, and reoperation within 6 months postoperatively) were compared between the 2 groups. Results There were no significant differences in perioperative basic conditions and complications and reoperation between the early and delayed operation groups. Postoperative hydronephrosis was greatly improved in both groups compared with the condition before operation(P<0.001), and better improvement was obtained in the delayed operation group than the early operation group, though no statistical difference(P=0.183). The thickness of renal parenchyma was improved in 28 cases(93.3%) in the early operation group and 10 cases(62.5%) in the delayed operation group, with obvious difference between them(P=0.026). Conclusion Early or delayed pyeloureteroplasty for UPJO complicated with infection in children have no significant effects on perioperative basic conditions, complications and reoperation. Delayed operation obtains slightly better improvement of hydronephrosis, but worse improvement in renal parenchyma thickness when compared with early operation. It is suggested that early removal for obstruction is helpful to the recovery of renal parenchyma so as to avoid further renal injury.
作者
韦超
张德迎
杨银
王萱
钟庆涛
刘星
华燚
林涛
何大维
李旭良
钟朝晖
魏光辉
WEI Chao;ZHANG Deying;YANG Yin;WANG Xuan;ZHONG Qingtao;LIU Xing;HUA Yi;LIN Tao;HE Dawei;LI Xuliang;ZHONG Chaohui;WEI Guanghui(Department of Urology,Chongqing Key Laboratory of Children Urogenital Development and Tissue Engineering,National Clinical Research Center for Child Health and Disorders,Key Laboratory of Child Development and Disorders of Ministry of Education,Chongqing Key Laboratory of Pediatrics,Children’s Hospital of Chongqing Medical University,Chongqing,400014;College of Public Health,Chongqing Medical University,Chongqing,400016,China)
出处
《陆军军医大学学报》
CAS
CSCD
北大核心
2022年第12期1261-1265,共5页
Journal of Army Medical University
基金
重庆市科卫联合项目(2019GDRC007)
重庆市渝中区基础研究与前沿探索项目(20200126)
重庆医科大学未来医学青年创新团队项目(W0056)。
关键词
肾盂输尿管连接处梗阻
上尿路感染
手术时机
儿童
ureteropelvic junction obstruction
upper urinary tract infection
surgical timing
children
