He Yuzhu, Song Hongcheng, Liu Pei, Sun Ning, Tian Jun, Li Minglei, Li Ning, Qu Yanchao, Han Wenwen, Feng Guoshuang, Ni Xin, Zhang Weiping
Department of Urology, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, 100045, China.
Center for Clinical Epidemiology & Evidence-Based Medicine, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, 100045, China.
J Pediatr Urol. 2020 Jun;16(3):331.e1-331.e11. doi: 10.1016/j.jpurol.2020.03.028. Epub 2020 Apr 10.
Laparoscopic pyeloplasty (LP) has been widely used in the treatment of pediatric ureteropelvic junction obstruction (UPJO). However, no prior reports with a large pediatric series have focused on the analysis of complications and impact factors of the outcomes. We hypothesized there were risk factors of higher Clavien grade postoperative complications.
To analyze the characteristics of complications and risk factors of high Clavien grade postoperative complications.
All children with UPJO treated with primary transperitoneal LP between July 2016 and July 2018 were retrospectively reviewed. The Clavien complication grades in groups with different weight, intraoperative complication (drainage methods), anteroposterior pelvic diameters (APPD), side, gender, title of surgeon, preoperative presentation and obstruction reason were compared.
Of the 279 children, intraoperative complications in which the placement of double-J stents was not accomplished and conversion to open surgery (Satava grade II) occurred in 17 (6.09%) and 2 (0.72%) patients, respectively. A total of 270 patients (277 kidneys) were included in the analysis of postoperative complications. Postoperative complications occurred in 51 (18.89%) patients. The most frequent postoperative incident was febrile UTI in 27 patients. Of the 13 patients who required reoperations, 6 patients had kidney restenosis and were considered as failure of surgery. All complications with an exact onset time occurred within 10 months after surgery. In the univariate and multivariate analysis, weight <10 kg and having intraoperative complication with nephrostomy tube were risk factors of higher Clavien postoperative complication grade (P＜0.05).
Patients who were <10 kg in weight and having intraoperative complication with nephrostomy tube had a greater risk of a higher Clavien grade postoperative complication. To reduce high Clavien grade postoperative complications, asymptomatic patients under 10 kg in weight and having intraoperative complication with nephrostomy tube need close monitoring. In the 26 patients who had an exact time of the postoperative complications, the longest time we found was 10 months. Thus, we recommend the follow-up time required to observe postoperative complications in patients should be at least 10 months after surgery.
LP has been proven to be safe and effective in children with a low rate of complications. Weight <10 kg and having intraoperative complications with nephrostomy tube were risk factors of higher Clavien grade postoperative complications. Children with low weight and intraoperative complications need more attention in terms of the occurrence of complications.
腹腔镜肾盂成形术（LP）已广泛应用于小儿输尿管肾盂连接部梗阻（UPJO）的治疗。然而，此前尚无大型小儿系列报道聚焦于并发症分析及影响预后的因素。我们推测存在导致术后并发症Clavien分级较高的危险因素。
分析并发症特点及术后Clavien分级较高的并发症的危险因素。
回顾性分析2016年7月至2018年7月间接受初次经腹LP治疗的所有UPJO患儿。比较不同体重、术中并发症（引流方式）、肾盂前后径（APPD）、手术侧别、性别、术者职称、术前表现及梗阻原因分组的Clavien并发症分级。
279例患儿中，分别有17例（6.09%）和2例（0.72%）患者术中出现双J管置入未成功及转为开放手术（Satava分级II级）的并发症。共有270例患者（277个肾脏）纳入术后并发症分析。术后并发症发生在51例（18.89%）患者中。最常见的术后事件是27例患者出现发热性尿路感染。在13例需要再次手术的患者中，6例存在肾脏再狭窄，被视为手术失败。所有确切发病时间的并发症均发生在术后10个月内。单因素和多因素分析中，体重<10 kg及术中出现肾造瘘管相关并发症是术后Clavien并发症分级较高的危险因素（P＜0.05）。
体重<10 kg且术中出现肾造瘘管相关并发症的患者术后发生Clavien分级较高并发症的风险更大。为降低术后Clavien分级较高的并发症，体重<10 kg且术中出现肾造瘘管相关并发症的无症状患者需要密切监测。在26例有确切术后并发症发生时间的患者中，我们发现最长时间为10个月。因此，我们建议观察患者术后并发症所需的随访时间应至少为术后10个月。
LP已被证明对小儿安全有效，并发症发生率低。体重<10 kg及术中出现肾造瘘管相关并发症是术后Clavien分级较高并发症的危险因素。体重低且术中出现并发症的患儿在并发症发生方面需要更多关注。
