Grapin C, Chartier-Kastler E, Audry G, Geraud M, Bruezière J, Gruner M
Service de Chirurgie Infantile, Hôpital Trousseau, Paris.
Ann Urol (Paris). 1989;23(2):142-5.
We report a series of 13 infants with failed surgery for pyeloureteral junction (PUJ) obstruction. Failure was defined as the necessity for further surgery, either re-fashioning of the anastomosis or nephrectomy. These infants were part of a series of 306 with 322 PUJ. Of the 258 surgically treated, 232 (90%) had a post operative course without complication or need for reoperation. The failure rate was significantly higher in infants operated before the age of 4 months (8/65: 12.3%) when compared with those over 4 months of age (5/193: 2.59%). The use of postoperative drainage via a nephrostomy significantly reduced the percentage of early complications (e.g. fistula) but did not affect the final failure rate. The severity of the obstruction at presentation correlated with a bad outcome after reoperation. Of the cases which resulted in failure after reoperation (7/258: 2.7%) all occurred in cases of severe obstruction with parenchymal damage. While the failure of surgery is often evident early (persistent fistula, urinoma, non functioning kidney on IVP) this may only become obvious some years later. Reoperations were successful in half of the cases irrespective of the time between the initial operation and the reoperation. Long term follow up of all infants operated for PUJ obstruction is recommended.
我们报告了一组13例肾盂输尿管连接部（PUJ）梗阻手术失败的婴儿。手术失败定义为需要进一步手术，即重新进行吻合术或肾切除术。这些婴儿是306例患有322处PUJ梗阻患儿中的一部分。在258例接受手术治疗的患儿中，232例（90%）术后病程无并发症或无需再次手术。与4个月以上的婴儿（5/193：2.59%）相比，4个月龄前接受手术的婴儿失败率显著更高（8/65：12.3%）。通过肾造瘘进行术后引流显著降低了早期并发症（如瘘管）的发生率，但并未影响最终的失败率。就诊时梗阻的严重程度与再次手术后的不良结局相关。在再次手术后导致失败的病例中（7/258：2.7%），均发生在伴有实质损害的严重梗阻病例中。虽然手术失败通常在早期就很明显（持续性瘘管、尿瘤、静脉肾盂造影显示肾脏无功能），但这可能在数年之后才变得明显。无论初次手术与再次手术之间的时间间隔如何，一半的再次手术病例是成功的。建议对所有接受PUJ梗阻手术的婴儿进行长期随访。
