原发性梗阻性巨输尿管在不同手术年龄的疗效比较

Comparison of Treatment Efficacy for Primary Obstructive Megaureter at Different Surgical Ages

摘要: 目的：随着产前超声诊断技术广泛地应用到临床工作中，原发性梗阻性巨输尿管的产前检出率和产后确诊率显著提升，但针对POM患儿的早期干预仍存在较多争议。旨在通过分析不同年龄段手术干预的临床结果，为POM患儿手术时机的决策提供科学依据。方法：对湖北省妇幼保健院2017年1月~2024年1月行腹腔镜膀胱外输尿管再植术的50例POM患儿开展回顾性队列分析。采集基线资料(性别、患侧、出生体重)、手术相关指标(手术时间、术中失血量、术后住院时间、术后引流时间)及术后恢复指标(输尿管最大直径、肾盂前后径及肾皮质厚度)。按手术年龄分层为A组(手术年龄 ≤ 3月龄)、B组(3月 < 手术年龄 ≤ 1岁)和C组(手术年龄 > 12月龄)。比较不同年龄患儿的基线资料、手术相关指标及术后恢复指标是否有差异。结果：共纳入50例接受腹腔镜膀胱外输尿管再植术的POM患儿。性别、患侧、出生体重、术后住院时间及术后引流时间在各组之间均无统计学差异(p > 0.05)。而B组的手术时间及术中失血量显著低于C组(p < 0.05)，A组的手术时间较C组缩短(p < 0.05)。组内纵向分析表明，术后输尿管最大直径、肾盂前后径及肾皮质厚度均较术前显著改善(p < 0.001)，组间横向比较显示术后恢复指标及其较术前改变情况均无统计学差异(p > 0.05)。结论：1) POM患儿在婴儿期行腹腔镜膀胱外输尿管再植术可获得较少的手术时长及术中失血量。2) 不同年龄组内的输尿管最大直径、肾盂前后径、肾皮质厚度均较术前有显著改善。3) 不同年龄组之间的术后恢复结果无统计学差异。

Abstract: Objective: With the widespread application of prenatal ultrasound diagnostic technology to clinical work, the prenatal detection rate and postnatal confirmation rate of primary obstructive megaureter have significantly increased, but the early intervention for children with POM is still controversial. To analyze the clinical outcomes of surgical interventions at different ages and provide a scientific basis for decision-making on the timing of surgery in children with POM. Methods: A retrospective cohort analysis of 50 children with POM who underwent laparoscopic extravesical ureteral reimplantation from January 2017 to January 2024 in Maternal and Child Health Hospital of Hubei Province. Baseline data (sex, affected side, birth weight), surgery-related indicators (duration of surgery, intraoperative blood loss, postoperative hospital stay, postoperative drainage time) and postoperative recovery indicators (maximum ureteral diameter, anterior and posterior renal pelvic diameters and renal cortical thickness) were collected. The children were stratified by age at surgery into group A (age at surgery ≤ 3 months), group B (3 months < age at surgery ≤ 1 year) and group C (age at surgery > 12 months). The baseline data, surgery-related indices and postoperative recovery indices of children of different ages were compared to see if there were any differences. Results: Fifty children with POM who underwent laparoscopic extravesical ureteral reimplantation were included. Gender, affected side, birth weight, postoperative hospital stay and postoperative drainage time were not statistically different between the groups (p > 0.05). Whereas the operative time and intraoperative blood loss were significantly lower in group B than in group C (p < 0.05), the operative time was shorter in group A than in group C (p < 0.05). Longitudinal analysis within groups showed that the maximum diameter of the ureter, anterior and posterior diameter of the renal pelvis and thickness of the renal cortex were significantly improved after surgery compared with the preoperative period (p < 0.001), and cross-section comparisons between groups showed that there was no statistically significant difference in the postoperative recovery indexes and their changes compared with the preoperative period (p > 0.05). Conclusion: 1) Laparoscopic extravesical ureteral reimplantation in infancy in children with POM resulted in less operative time and intraoperative blood loss. 2) The maximum ureteral diameter, anterior and posterior renal pelvic diameters, and renal cortical thickness within different age groups were significantly improved compared with the preoperative period. 3) There was no statistically significant difference in postoperative recovery outcomes between the different age groups.