Wang Jian, Mou Yaru, Li Aiwu
Department of Pediatric Surgery, Qilu Hospital of Shandong University, Jinan, China.
Department of Cardiology, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, China.
J Laparoendosc Adv Surg Tech A. 2020 Mar;30(3):328-333. doi: 10.1089/lap.2018.0791. Epub 2020 Jan 29.
In this article, we report our experience on laparoscopic pneumovesical Cohen approach for vesicoureteral junction (VUJ) stricture in children and compared it with traditional open Cohen approach. Ninety-eight children (114 ureters) with VUJ stricture were involved in this study who were treated from January 2008 to December 2017. Forty-eight patients (56 ureters) treated with open Cohen approach from January 2008 to December 2011 were marked as Group 1 and 50 patients (58 ureters) treated with laparoscopic pneumovesical Cohen approach from January 2012 to December 2017 were marked as Group 2. The preoperative data, operative details, and follow-up outcomes were studied and compared between two groups to discuss the advantages of the laparoscopic pneumovesical approach. Statistical comparison was made with unpaired -tests, χ tests, and Fisher exact probabilities, with value <.05 was considered significant. To bring less related effect during comparison, patients with similar preoperative data were selected. The time of operation of Group 2 was longer than that of Group 1, and the operation of Group 2 was completed with the laparoscopic pneumovesical approach in all but 1 patient (1 ureter), which was converted to open surgery. However, the postoperative gross hematuria duration, antibiotics consumption, retention time of urinary catheter, and hospital stay after surgery were shorter in Group 2 with less intraoperative blood loss, less postoperative complications, and less drainage catheter. All patients were followed up by ultrasonography, excretory retrograde urography, and magnetic resonance urogram for 3-24 months (mean 15.6 months) and the recovery and improvement were better in Group 2. Compared with open surgery, the laparoscopic pneumovesical approach has many benefits and was effective for the treatment of obstructive megaureter in children.
在本文中，我们报告了我们采用腹腔镜充气膀胱Cohen术治疗儿童膀胱输尿管连接部（VUJ）狭窄的经验，并将其与传统开放性Cohen术进行了比较。本研究纳入了2008年1月至2017年12月期间接受治疗的98例患有VUJ狭窄的儿童（114条输尿管）。2008年1月至2011年12月采用开放性Cohen术治疗的48例患者（56条输尿管）被标记为第1组，2012年1月至2017年12月采用腹腔镜充气膀胱Cohen术治疗的50例患者（58条输尿管）被标记为第2组。对两组患者的术前数据、手术细节和随访结果进行了研究和比较，以探讨腹腔镜充气膀胱术的优势。采用非配对t检验、χ²检验和Fisher精确概率法进行统计学比较，P值<0.05被认为具有统计学意义。为了在比较过程中减少相关影响，选择了术前数据相似的患者。第2组的手术时间比第1组长，除1例患者（1条输尿管）转为开放手术外，第2组的手术均采用腹腔镜充气膀胱术完成。然而，第2组术后肉眼血尿持续时间、抗生素使用量、导尿管留置时间和术后住院时间较短，术中出血量较少，术后并发症较少，引流管较少。所有患者均通过超声、排泄性逆行尿路造影和磁共振尿路造影进行了3至24个月（平均15.6个月）的随访，第2组的恢复和改善情况更好。与开放手术相比，腹腔镜充气膀胱术有许多优点，对治疗儿童梗阻性巨输尿管有效。
