Bustangi Nasir, Kallas Chemaly Anthony, Scalabre Aurelien, Khelif Karim, Luyckx Stéphane, Steyaert Henri, Varlet Francois, Lopez Manuel
Department of Pediatric Surgery and Urology, King Abdulaziz University Hospital, Jeddah, Saudi Arabia.
Department of Pediatric Surgery and Urology, Faculty of Medicine, Hôtel-Dieu de France, Beirut, Lebanon.
Front Pediatr. 2018 Dec 18;6:388. doi: 10.3389/fped.2018.00388. eCollection 2018.
The aim is to compare the outcome of open versus laparoscopic Lich-Gregoir technique in patients with vesicoureteral reflux. We report a retrospective multicenter comparative study between open and laparoscopic extra-vesical ureteral reimplantation (EVUR) following Lich-Gregoir (LG) technique for the correction of Vesico-Ureteral Reflux (VUR). Between January 2007 and December 2015, 96 patients with VUR (69 females and 27 males) and deterioration of the renal function, underwent EVUR following LG technique. Fifty patients (16 males and 34 females) were operated by open surgery (group A). The mean age was 4.22 years-old, (14-147 months). Laparoscopic approach (group B) was performed in 46 patients (11 males and 35 females). The mean age was 4.19 years-old (15-110 months). We compared the results in relation to degree of VUR, operative time, hospital stay, post-operative pain medications, recovery time, complications, successful rate, recurrence, and follow-up. Statistical analysis was done used Chi square test for categorical variables and the Student -test for continuous variables. < 0.05 was considered significant. In both groups no correlation was identified between age or weight and operative time, length of stay or total analgesia used. The mean operative time for group A was 63.2 and 125.4 min for unilateral and bilateral VUR, respectively, and for the group B was 127.90 and 184.5 min, respectively. There was no conversion in the laparoscopic group. Perioperative mucosal perforation of the bladder occurred in 6 patients of group A and 4 patients of group B and was immediately repaired. One patient had to be reoperated for leakage in group B. The mean duration of Morphine, IV and PO analgesia was shorter in group B. The mean hospital stay was 5.46 days for group A and 1.54 days for Group B. The success rate was 98% in group A and 97, 8% in group B. The mean follow-up was 3.67 years for the open and 1.54 years for the laparoscopic group. Transitory voiding dysfunction occurred in bilateral EVUR in one case in each group. Laparoscopic or Open approach for the correction of VUR following Lich-Gregoir technique is effective in unilateral and bilateral VUR with similar results. Laparoscopic approach reduces significantly ( < 0.05 in each item) post-operative pain medication, hospital stay, and allows for a faster return to normal activity.
目的是比较开放手术与腹腔镜下利奇-格雷戈尔技术治疗膀胱输尿管反流患者的疗效。我们报告了一项回顾性多中心比较研究，该研究对比了采用利奇-格雷戈尔（LG）技术进行开放手术和腹腔镜下膀胱外输尿管再植术（EVUR）治疗膀胱输尿管反流（VUR）的效果。在2007年1月至2015年12月期间，96例患有VUR且肾功能恶化的患者接受了LG技术下的EVUR手术。50例患者（16例男性和34例女性）接受了开放手术（A组）。平均年龄为4.22岁（14 - 147个月）。46例患者（11例男性和35例女性）采用了腹腔镜手术方式（B组）。平均年龄为4.19岁（15 - 110个月）。我们比较了两组在VUR程度、手术时间、住院时间、术后止痛药物使用情况、恢复时间、并发症、成功率、复发率及随访等方面的结果。对分类变量采用卡方检验进行统计分析，对连续变量采用学生t检验。P < 0.05被认为具有统计学意义。在两组中，均未发现年龄或体重与手术时间、住院时长或总镇痛药物使用量之间存在相关性。A组单侧和双侧VUR的平均手术时间分别为63.2分钟和125.4分钟，B组分别为127.90分钟和184.5分钟。腹腔镜组无中转开腹情况。A组有6例患者、B组有4例患者发生术中膀胱黏膜穿孔，均立即进行了修补。B组有1例患者因漏尿需再次手术。B组吗啡静脉及口服镇痛的平均持续时间较短。A组平均住院时间为5.46天，B组为1.54天。A组成功率为98%，B组为97.8%。开放手术组平均随访3.67年，腹腔镜组平均随访1.54年。每组各有1例双侧EVUR患者出现短暂性排尿功能障碍。采用利奇-格雷戈尔技术进行腹腔镜或开放手术治疗单侧和双侧VUR均有效，结果相似。腹腔镜手术方式能显著减少（各项均P < 0.05）术后止痛药物使用量和住院时间，并能使患者更快恢复正常活动。
