摘要
目的:探讨腹腔镜逆行肾造瘘术在婴儿肾盂输尿管连接部梗阻(ureteropelvic junction obstruction,UPJO)行肾盂成形术中双J管置入膀胱困难的病例中的临床应用价值。方法:回顾性分析2012年6月—2025年5月在山西省儿童医院行腹腔镜肾盂成形术、年龄小于1岁的159例患儿的临床资料,其中男146例,女13例,年龄1~12个月;左侧105例,右侧29例,双侧25例。将术中双J管置入膀胱困难、行逆行肾造瘘术的患儿作为试验组(30例),将术中双J管置入膀胱顺利的患儿作为对照组(129例)。分析2组在性别、年龄、术前肾盂前后径、手术时间、出血量、住院时间等方面的差异。结果:试验组与对照组在性别、年龄、术前肾盂前后径、手术时间、出血量、住院时间等方面比较均差异无统计学意义。试验组术后11d拔除输尿管支架管,术后12d行肾盂测压及经造瘘管顺行肾盂造影,其中27例提示输尿管远端通畅,顺利拔除肾造瘘管。2例术后12d及术后8周行肾盂测压及顺行肾盂造影,提示输尿管膀胱交界处梗阻,后行再植术。1例患儿因首次手术曾多次尝试置入双J管导致输尿管膀胱交界处瘢痕狭窄,后行再植术。结论:婴儿腹腔镜肾盂成形术中,如双J管顺行置入膀胱失败,可选择腹腔镜下逆行肾造瘘术。手术过程简单易行,可为可能的二次手术创造条件,值得推广应用。
Objective:To evaluate the clinical application of retrograde nephrostomy in cases of difficulty in double J tube insertion into bladder during operation for UPJO in infant.Methods:This study retrospectively analyzed 159pediatric cases under 1year old(aged 1-12months;146males vs 13females;105left-sided vs 29rightsided;25bilateral)undergoing laparoscopic pyeloplasty from June 2012to May 2025.Patients were divided into experimental group(n=30)and control group(n=129)based on retrograde nephrostomy status.The study included 30infants who failed to be successfully placed a double-J stent during surgery and underwent retrograde nephrostomy as the experimental group,compared with 129infants who had successful stent placement as the control group.Analysis was conducted on differences between groups in gender,age,preoperative anteroposterior diameter of renal pelvis,surgical duration,blood loss,and hospitalization duration.Results:There was no statistical difference between the experimental group and the control group in terms of gender,age,preoperative anteroposterior diameter of renal pelvis,operation time,blood loss or hospitalization time.The ureteral stent was removed 11days postoperatively.A day later,a renal pelvis pressure test and antegrade pyelography through the nephrostomy tube were performed.Among 27cases,distal ureteral patency was confirmed,allowing successful removal of the nephrostomy tube.Two patients underwent follow-up pressure tests and antegrade pyelography at 12days and 8weeks postoperatively,respectively,revealing ureterovesical junction obstruction requiring subsequent reimplantation.One infant developed ureterovesical junction stenosis due to repeated attempts to insert a double-J tube during initial surgery,necessitating reimplantation.Conclusion:For infants,if the double-J tube can not be inserted into the bladder during laparoscopic pyeloplasty,laparoscopic retrograde nephrostomy can be selected.The operation process is simple and easy to perform,which can create facilities for possible secondary surgery,and it is worth popularizing and applying.
作者
王玮
张旭辉
罗添华
孟庆明
陈柏峰
席红卫
WANG Wei;ZHANG Xuhui;LUO Tianhua;MENG Qingming;CHEN Baifeng;XI Hongwei(Department of Urology,Shanxi Children’s Hospital,Taiyuan,030001,China)
出处
《临床泌尿外科杂志》
2025年第11期997-1000,共4页
Journal of Clinical Urology
基金
山西省自然科学研究面上项目基金(No:202303021211064)。
关键词
逆行肾造瘘
肾盂输尿管连接部梗阻
婴儿
retrograde nephrostomy
ureteropelvic junction obstruction
infant
