高海拔地区腹腔镜离断式肾盂成形术治疗疗效分析——以我院61例小儿先天性肾积水为例

Analysis of Therapeutic Effects of Laparoscopic Detached Pyeloplasty in High-Altitude Areas—Taking 61 Cases of Congenital Hydronephrosis in Children in Our Hospital as an Example

摘要: 目的：探讨腹腔镜离断式肾盂输尿管成形术治疗肾盂输尿管连接部梗阻(UPJO)肾积水的临床疗效及总结手术经验。方法：回顾性分析我院2014年3月~2021年3月收治的61例小儿UPJO患者，所有患者均行经腹腔镜肾盂成形术，其中男43例，女18例，年龄3~14岁，左侧37例，右侧24例。结果：所有手术均成功完成，其中31例系体检发现，30例因有明显腰痛症状就诊，其中5例因术前重度积水先行患肾造瘘1月后再行手术治疗，正常手术患者术后3~11天拔出引流管，术后5~12天出院，手术时间95~320分钟，术中出血10~100 ml，平均随访时间9 (6~12)个月，B超提示患肾积水较术前明显减轻，部分患者CTU提示肾实质厚度增加，无明显梗阻，患肾功能不同程度恢复，术前腰背部不适、腹痛及发热等症状主观上明显改善，但其中有2例术后复查时肾积水缓解不明显，6个月后行二次手术治疗，手术为经腰切口开放手术。结论：腹腔镜离断式肾盂输尿管成形术治疗UPJO可有效缓解患者肾积水，缓解患者术前腰背部不适等主观症状，并且可不同程度恢复患肾功能。

Abstract: Objective: Exploring the clinical efficacy and summarizing surgical experience of laparoscopic detachable pyeloureteroplasty for the treatment of hydronephrosis caused by obstruction of the renal pelvis ureteral junction (UPJO). Methods: A retrospective analysis was conducted on 61 pediatric UPJO patients admitted to our hospital from March 2014 to March 2021. All patients underwent laparoscopic pyeloplasty, including 43 males and 18 females, aged 3~14 years, with 37 on the left and 24 on the right. Results: All surgeries were successfully completed, among which 31 cases were found during physical examination, 30 cases sought medical attention due to obvious symptoms of lower back pain, 5 cases suffered from severe preoperative hydronephrosis and underwent nephrostomy for 1 month before surgery. Normal surgical patients had their drainage tubes removed 3~11 days after surgery, and were discharged 5~12 days after surgery. The surgery lasted 95~320 minutes, with intraoperative bleeding of 10~100 ml and an average follow-up time of 9 (6~12) months. B-ultrasound showed a significant reduction in hydronephrosis compared to preoperative. Some patients showed an increase in renal parenchymal thickness and no obvious obstruction on the CTU, with varying degrees of recovery in renal function. Symptoms such as preoperative lumbar and back discomfort, abdominal pain, and fever were subjectively significantly improved. However, there were 2 cases where renal hydronephrosis did not improve significantly during postoperative follow-up, and a second surgery was performed 6 months later. The surgery was an open surgery through a lumbar incision. Conclusion: Laparoscopic detachable pyeloureteroplasty for UPJO can effectively alleviate hydronephrosis, alleviate subjective symptoms such as preoperative lumbar discomfort, and restore renal function to varying degrees.