小儿输尿管上皮息肉的诊治及术后引流方式：单中心10年观察研究

Diagnosis and Treatment of Pediatric Ureteral Epithelial Polyps and Postoperative Drainage Patterns: A Single-Center, 10-Year Observational Study

摘要: 目的：总结输尿管上皮息肉的治疗及管理经验。方法：回顾性分析我中心近十年对输尿管息肉的治疗方式及管理，共73患者纳入研究，按治疗方式分为三组：腹腔镜手术组(n = 50)，开放式手术组(n = 20)，输尿管镜下切除术组(n = 3)。对比腹腔镜手术组与开放式手术组完全切除率、手术时间、住院时间、复发率及术后并发症。同时分析输尿管镜下息肉切除术的结局。纳入研究的患儿按术中置管方式分为：双J管内引流组(n = 38)，支架管外引流组(n = 32)，在术后5天比较输尿管支架症状问卷(USSQ)评分表中下尿路症状、一般情况、身体疼痛的情况及并发症发生率。结果：腹腔镜手术组手术时间、住院时间小于开放式手术组，差异有统计学意义(p < 0.01)。腹腔镜手术组与开放手术组的完全切除率、复发率、术后并发症率无明显差异。输尿管镜下切除术组完全切除率66.7%，术后无并发症。双J管内引流组和支架管外引流组USSQ中的下尿路症状、一般情况、身体疼痛无明显差异(p > 0.05)。两组并发症发生率无明显差异(p > 0.05)。结论：腹腔镜治疗输尿管息肉较开放式手术有明显优势，但手术医生操作不熟练或者遇到较为复杂的输尿管息肉时，应该谨慎考虑。同时，输尿管镜下切除息肉是一种微创的手术，并发症及复发率低，但操作难度较大，可用于单一病变且大龄患儿。术后引流管应首选支架管外引流，可通过冲洗解除引流不畅，同时避免了膀胱镜取双J管的有创操作，也减轻患者家庭经济负担。

Abstract: Objective: To summarize the experience in the treatment and management of ureteral epithelial polyps. Methods: To retrospectively analyze the treatment and management of ureteral polyps in our center in the past ten years, a total of 73 patients were included in the study, and they were divided into three groups according to the treatment: laparoscopic group (n = 50), open surgery group (n = 20), and ureteroscopic resection group (n = 3). The complete resection rate, operative time, hospital stay, recurrence rate and postoperative complications were compared between the laparoscopic surgery group and the open surgery group. The outcome of ureteroscopic polypectomy was also analyzed. The children included in the study were divided according to intraoperative tube placement: double J tube drainage group (n = 38) and stent tube external drainage group (n = 32), and the lower urinary tract symptoms, general condition, physical pain and complication rate on the Ureteral Stent Symptom Questionnaire (USSQ) rating scale were compared at 5 days postoperatively. Results: The operative time and hospital stay were less in the laparoscopic surgery group than in the open surgery group, and the difference was statistically significant (p < 0.01). There was no significant difference in the complete resection rate, recurrence rate, and postoperative complication rate between the laparoscopic surgery group and the open surgery group. The complete resection rate in the ureteroscopic resection group was 66.7% with no postoperative complications. There were no significant differences in lower urinary tract symptoms, general condition, or physical pain in the USSQ between the double J-tube drainage group and the stent-external drainage group (p > 0.05). There was no significant difference in complication rates between the two groups (p > 0.05). Conclusion: Laparoscopic treatment of ureteral polyps has obvious advantages over open surgery, but it should be carefully considered when the surgeon is unskilled or encounters more complicated ureteral polyps. At the same time, ureteroscopic polypectomy is a minimally invasive procedure with low complication and recurrence rates, but it is more difficult to perform and can be used for single lesions and older children. The postoperative drainage tube should be preferred to stent external drainage, which can be relieved by irrigation to relieve drainage obstruction and avoid the invasive operation of cystoscopy to take double J-tubes, and also reduce the economic burden of the patient’s family.