Rudrawadi Sharanbasappa, Kochhar Gaurav, Shekhar P Ashwin, Laddha Prateek Jugalkishore
Department of Urology, Sri Sathya Sai Institute of Higher Medical Sciences, Anantapur, Andhra Pradesh, India.
J Indian Assoc Pediatr Surg. 2021 Sep-Oct;26(5):294-298. doi: 10.4103/jiaps.JIAPS_141_20. Epub 2021 Sep 16.
To determine the efficacy and outcome of pyeloplasty in poorly functioning kidneys in the pediatric population and whether pyeloplasty could be offered as an upfront procedure in such patient population, instead of nephrectomy.
A retrospective data analysis of 83 patients who underwent pyeloplasty in poorly functioning kidneys from 2010 to 2015 was performed. Success was defined based on improvement in symptoms, stable or improved function, and better drainage on post-operative Tc-99m Diethylene Triamine Pentaacetic acid scan instead of DTPA scan renography done after 3 months and yearly thereafter.
Eighty-three patients with a mean age of 6.8 ± 2.88 years with poor function on isotope renogram (<30%) were included in the study. Three patients were excluded in view of postoperative outflow obstruction. Out of the remaining 80 patients, 56 were male and 24 were female. They were divided into two groups based on preoperative differential renal function (DRF), Group I ( = 26) having preoperative DRF of <10% and Group II ( = 54) having preoperative DRF of 10%-30%. All patients underwent laparoscopic dismembered pyeloplasty with ureteral stenting. The mean DRF improved from 7.58 ± 2.39 to 29.71 ± 5.16 postoperatively in Group I. However, in Group II, DRF improved from 20.81 ± 5.68 to 37.25 ± 7.11 postoperatively. At a follow-up of 24 months, the overall success rate was 98%.
Pyeloplasty gives good intermediate-term results even in extremely poorly functioning kidneys and an upfront pyeloplasty instead of nephrectomy should be offered to all pediatric patients irrespective of preoperative function.
确定肾盂成形术对小儿肾功能不佳肾脏的疗效及结果，以及在这类患者群体中肾盂成形术能否作为首选手术，而非肾切除术。
对2010年至2015年接受肾功能不佳肾脏肾盂成形术的83例患者进行回顾性数据分析。成功的定义基于症状改善、功能稳定或改善，以及术后99m锝二乙烯三胺五乙酸扫描显示引流改善，而非术后3个月及之后每年进行的二巯基丁二酸扫描肾图。
本研究纳入了83例平均年龄为6.8±2.88岁、同位素肾图显示功能不佳（<30%）的患者。鉴于术后出现流出道梗阻，3例患者被排除。在其余80例患者中，56例为男性，24例为女性。根据术前分肾功能（DRF）将他们分为两组，第一组（n = 26）术前DRF<10%，第二组（n = 54）术前DRF为10%-30%。所有患者均接受了腹腔镜离断性肾盂成形术并置入输尿管支架。第一组术后平均DRF从7.58±2.39提高到29.71±5.16。然而，第二组术后DRF从20.81±5.68提高到37.25±7.11。在24个月的随访中，总体成功率为98%。
即使对于功能极差的肾脏，肾盂成形术也能取得良好的中期效果，对于所有小儿患者，无论术前肾功能如何，均应首选肾盂成形术而非肾切除术。
