手术方式是否会改变肾盂成形术前逆行肾盂造影的必要性？

Does the surgical approach change the need for a retrograde pyelogram prior to pyeloplasty?

作者信息

Narayanan Sarath Kumar, Smith Grahame, Thomas Gordon, Cohen Ralph Clinton

机构信息

Department of Pediatric Surgery, The Children's Hospital at Westmead, Locked Bag 4001, Westmead 2145, NSW, Australia.

出版信息

J Pediatr Urol. 2014 Oct;10(5):835-9. doi: 10.1016/j.jpurol.2014.01.032. Epub 2014 Mar 12.

DOI:10.1016/j.jpurol.2014.01.032

PMID:24690464

Abstract

OBJECTIVE

The opinion on the use of retrograde ureteropyelography (RUPG) prior to routine pyeloplasty for an ureteropelvic (UPJ) obstruction has been divided. This study analyses the efficacy of a preoperative RUPG and determines if a dorsal lumbotomy (DL) approach offers any advantage in this situation.

METHODS

This is a retrospective analysis of application of RUPG prior to pyeloplasty in children with ages ranging from 42 days to 16.2 years who underwent surgery at the Children's Hospital at Westmead between 2009 and 2013.

RESULTS

We identified a total of 95 children with isolated UPJ obstruction, with 59 (62.1%) boys and 36 (37.8%) girls. Overall, open pyeloplasties were performed in 89 (42 DL: 47 loin incision) and the rest (n = 6) laparoscopically. Preoperative RUPG was performed in 58 (61%) and it provided additional information in 11 (18.9%) patients for whom the surgical approach was modified. Hospital stay, operative time, and time to full diet were shorter with the DL approach (p < 0.05).

CONCLUSIONS

The current study suggests that RUPG is avoidable if the approach for pyeloplasty is through the conventional loin incision. The short-term advantages might rationalize the use of RUPG if a DL incision is employed.

摘要

目的

对于在常规肾盂成形术治疗肾盂输尿管连接部（UPJ）梗阻之前使用逆行输尿管肾盂造影（RUPG），各方观点不一。本研究分析术前RUPG的疗效，并确定在这种情况下背侧腰部切开术（DL）入路是否具有任何优势。

方法

这是一项对2009年至2013年在韦斯特米德儿童医院接受手术的年龄在42天至16.2岁之间的儿童肾盂成形术前应用RUPG的回顾性分析。

结果

我们共确定了95例孤立性UPJ梗阻患儿，其中男孩59例（62.1%），女孩36例（37.8%）。总体而言，89例（42例采用DL：47例采用腰部切口）进行了开放性肾盂成形术，其余6例采用腹腔镜手术。58例（61%）患儿进行了术前RUPG，其中11例（18.9%）患者因该检查获得的额外信息而改变了手术入路。采用DL入路时，住院时间、手术时间和恢复正常饮食的时间更短（p < 0.05）。