小儿肾盂成形术失败后行肾盂内切开术与再次肾盂成形术的治疗：单中心经验
Endopyelotomy versus redo pyeoloplasty for management of failed pyeloplasty in children: A single center experience.
作者信息
Abdrabuh Abdrabuh M, Salih Elsayed M, Aboelnasr Mahmoud, Galal Hussein, El-Emam Abdelbasset, El-Zayat Tarek
机构信息
Department of urology, Al-Azhar university Hospitals, Cairo, Egypt.
Department of urology, Al-Azhar university Hospitals, Cairo, Egypt.
出版信息
J Pediatr Surg. 2018 Nov;53(11):2250-2255. doi: 10.1016/j.jpedsurg.2018.06.002. Epub 2018 Jun 7.
PURPOSE
We compared endopyelotomy to redo pyeloplasty for the treatment of failed pyeloplasty in children to identify factors that may have an impact on outcome and favor one procedure over the other.
METHODS
Of 43 patients with recurrent UPJO, EP was performed in 27 and RP was performed in 16. Age, gender, side, presentation of secondary UPJO, hospital stay, complications and success rates were compared. Success was defined as radiographic relief of obstruction as determined by ultrasound or diuretic renography at latest follow-up.
RESULTS
Mean (Range) patient age was 7.2 years (range 6 months to 17 years) in EP (group 1) while 7.4 (range 6 months to 17 years) in RP (group 2). EP technique consisted of retrograde cold-knife in 17 patients, retrograde holmium laser in 8 and antegrade cold-knife in 2. RP was performed in 16 patients. All the patients with failed EP had a stricture greater than 15 mm. Mean length of the narrowed ureteral segment was 17.8 mm in the failed EP group vs 10 mm in the successful group (p < 0.001). Mean Hospital stay was 1 day for the EP group and 5 days for the RP group (p < 0.001). Mean follow-up was 17 months (range 12 to 43) after EP and 21 months (12 to 51) after RP. There was no statistical significance between both groups regarding the postoperative degree of hydronephrosis, parenchymal thickness, split renal functions and renal drainage. The overall success was (86%); the success was nonsignificantly higher in RP (93.8%) vs (81.5%) in EP.
CONCLUSION
In selected children, retrograde endopyelotomy is safe and may give comparable short-term outcomes as open redo pyeloplasty for correction of secondary UPJO after failed pyeloplasty. Narrowed ureteral segment greater than 15 mm and preoperative grade 4 hydronephrosis were factors significantly associated with a poor outcome after EP.
A LEVEL-OF-EVIDENCE RATING FOR CLASSIFYING STUDY QUALITY: LEVEL III Retrospective comparative study.
目的
我们比较了肾盂内切开术与再次肾盂成形术治疗儿童肾盂成形术失败的情况，以确定可能影响治疗结果的因素，并判断哪种手术更具优势。
方法
43例复发性肾盂输尿管连接部梗阻（UPJO）患者中，27例行肾盂内切开术（EP），16例行再次肾盂成形术（RP）。比较两组患者的年龄、性别、患侧、继发性UPJO的表现、住院时间、并发症及成功率。成功定义为在最近一次随访时，通过超声或利尿肾图检查显示梗阻在影像学上得到缓解。
结果
EP组（第1组）患者的平均（范围）年龄为7.2岁（6个月至17岁），而RP组（第2组）为7.4岁（6个月至17岁）。EP技术包括17例逆行冷刀切开、8例逆行钬激光切开和2例顺行冷刀切开。16例患者接受了RP手术。所有EP手术失败的患者狭窄段均大于15mm。EP手术失败组狭窄输尿管段的平均长度为17.8mm，而成功组为10mm（p<0.001）。EP组平均住院时间为1天，RP组为5天（p<0.001）。EP术后平均随访17个月（12至43个月），RP术后平均随访21个月（12至51个月）。两组在术后肾积水程度、实质厚度、分肾功能及肾脏引流方面无统计学差异。总体成功率为86%；RP组成功率（93.8%）略高于EP组（81.5%），但无显著差异。
结论
对于特定儿童，逆行肾盂内切开术是安全的，在纠正肾盂成形术失败后的继发性UPJO方面，其短期效果与开放性再次肾盂成形术相当。输尿管狭窄段大于15mm和术前4级肾积水是EP术后预后不良的显著相关因素。
研究质量分类的证据等级
III级回顾性比较研究。
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