Department of Paediatric Surgery and Urology, Medical University, Wroclaw, Poland.
Urology. 2011 Oct;78(4):891-4. doi: 10.1016/j.urology.2011.04.039. Epub 2011 Jun 25.
To assess the outcomes of nondismembered pyeloplasty for ureteropelvic junction obstruction in a pediatric population of children and adolescents.
Between 2005 and 2009, a total of 129 pyeloplasties were performed at our institution. In all, 34 (24%) renal units underwent primary nondismembered Fenger-type plasty, 22 open (OPEN) and 12 laparoscopic (LAP). Gender distribution, left to right ratio, follow-up period, grade of kidney dilatation and split renal function were similar in both groups. The decision to perform a nondismembered procedure was made by the surgeon intraoperatively. The mean age at surgery was 4.5 years for the OPEN group and 14.2 years for the LAP group. Mean follow-up was 30 months (range 12-70 months).
The overall success rate was 91% (95.5% the OPEN group and 83.5% in the LAP group). Secondary surgery was required for 3 renal units. Other complications included pyelonephritis in 3 patients (2 in OPEN and 1 in LAP), ileus in 1 patient (OPEN), and prolonged postoperative pain in 1 patient (LAP). The mean operation time was significantly shorter for open surgery (95 minutes for OPEN vs 179 minutes for LAP; P < .05). There was no significant difference in the length of the postoperative hospital stay (2.5 days for OPEN vs 3 days for LAP).
Nondismembered pyeloplasty is an effective procedure for curing ureteropelvic junction obstruction in the pediatric population, and can be considered as an option in well selected cases.
评估非离断式肾盂成形术治疗儿童和青少年肾盂输尿管连接部梗阻的疗效。
2005 年至 2009 年,我院共进行了 129 例肾盂成形术。其中 34 个(24%)肾单位行原发性非离断式 Fenger 型成形术,22 例开放(OPEN)手术,12 例腹腔镜(LAP)手术。两组的性别分布、左右比例、随访时间、肾扩张程度和分肾功能相似。非离断手术的决策是由术者术中决定的。OPEN 组手术时的平均年龄为 4.5 岁,LAP 组为 14.2 岁。平均随访时间为 30 个月(12-70 个月)。
总的成功率为 91%(OPEN 组为 95.5%,LAP 组为 83.5%)。有 3 个肾单位需要二次手术。其他并发症包括 3 例肾盂肾炎(2 例 OPEN,1 例 LAP)、1 例肠梗阻(OPEN)和 1 例术后疼痛持续时间延长(LAP)。开放手术的平均手术时间明显短于腹腔镜手术(OPEN 为 95 分钟,LAP 为 179 分钟;P<0.05)。术后住院时间无显著差异(OPEN 为 2.5 天,LAP 为 3 天)。
非离断式肾盂成形术是治疗小儿肾盂输尿管连接部梗阻的有效方法,可作为选择病例的一种选择。