Lasso-Betancor C E, Castellan M, Yanes R, Labbie A, Gosalbez R
Servicio de Urología Pediátrica, Miami Children's Hospital, Jackson Memorial Hospital, Florida, EE. UU.
Actas Urol Esp. 2012 Sep;36(8):469-73. doi: 10.1016/j.acuro.2012.03.007. Epub 2012 Jun 17.
In spite of advances in minimally invasive endoscopic surgery, open dismembered pyeloplasty continues to be used in many pediatric centers, especially in small children. The purpose of this work is to present our experience in the performance of this technique using a minimally invasive open pyeloplasty without intrarenal stents.
A retrospective review was made of patients between July 1992 and July 2009. During this time, 348 patients underwent open dismembered pyeloplasty. A total of 310 patients (89%), 223 boys and 87 girls, underwent open pyeloplasty without intrarenal stent. The incision was from 2 to 2.5 cm in the flank. An extrarenal drain (3-5 days) and a bladder catheter (< 24 hs) were placed in all patients.
A total of 319 pyeloplasties were performed without intrarenal catheter in our Service. Of these, 174 (54.5%) were on the left side, 127 (39.8%) on the right side and 9 (5.6%) were bilateral. Age interval was 14 days to 18 years, 58% of the children being younger than 12 months at the time of surgery. With a mean follow-up of 6.7 years (17 years to 11 months), 312 pyeloplasties (97.8%) were successful, with persistence of the obstructive patient in 7 patients who required a new open pyeloplasty (2.2%). Other complications were: prolonged drainage (6), wound infection (1), and urinary infection (2). Mean stay was 22 hours.
Open dismembered pyeloplasty is a safe and effective treatment choice for pyeloureteral stenosis in children and can be done without intrarenal stents with no detriment to its success.
尽管微创内镜手术取得了进展，但开放式离断性肾盂成形术仍在许多儿科中心使用，尤其是在幼儿中。本研究的目的是介绍我们使用无肾内支架的微创开放式肾盂成形术实施该技术的经验。
对1992年7月至2009年7月期间的患者进行回顾性研究。在此期间，348例患者接受了开放式离断性肾盂成形术。共有310例患者（89%），其中223例男孩和87例女孩，接受了无肾内支架的开放式肾盂成形术。切口位于侧腹，长度为2至2.5厘米。所有患者均放置了肾外引流管（3 - 5天）和膀胱导管（< 24小时）。
我们科室共进行了319例无肾内导管的肾盂成形术。其中，174例（54.5%）在左侧，127例（39.8%）在右侧，9例（5.6%）为双侧。年龄范围为14天至18岁，58%的儿童在手术时年龄小于12个月。平均随访6.7年（17年至11个月），312例肾盂成形术（97.8%）成功，7例梗阻患者仍需再次进行开放式肾盂成形术（2.2%）。其他并发症包括：引流时间延长（6例）、伤口感染（1例）和泌尿系统感染（2例）。平均住院时间为22小时。
开放式离断性肾盂成形术是治疗儿童肾盂输尿管狭窄的一种安全有效的方法，不使用肾内支架也不会影响其成功率。
