Bao Qiao, Ma Weijun, Zhang Xiewu, Chen Shuhan, Luo Jiayao, Zhang Gang, Lao Weihua, Chen Yueqing
Department of Pediatric Urology, Guangdong Women and Children Hospital, Guangzhou, China.
Department of Pediatric Surgery, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.
Front Pediatr. 2022 Oct 19;10:1022836. doi: 10.3389/fped.2022.1022836. eCollection 2022.
The treatment timing of ureteropelvic junction obstruction (UPJO) in infants remains controversial. This study aimed to compare the recovery effect of renal morphology of immediate and delayed laparoscopic pyeloplasty in infants with severe UPJO.
The infants with severe UPJO-induced hydronephrosis who underwent laparoscopic pyeloplasty according to their age at the time of surgery [the immediate treatment (IT) group: ≤1 month of birth, the delayed treatment (LT) group: 3-6 months of birth] in our center between 2010 and 2019 were enrolled in this study. Ultrasonography was used to assess renal morphology, including anteroposterior diameter (APD) of a pelvic, parenchymal thickness (PT), polar length (PL), and Society of Fetal Urology (SFU) grade. Preoperative and postoperative renal morphological outcomes at 6, 12, and 24 months were measured and compared.
During this period, a total of 135 patients were assigned to receive either IT ( = 73) or LT ( = 62) and were included for analysis. There were no significant differences in renal morphology indices at baseline between groups of IT and LT. The APD, PT, and PL in both groups all recovered to certain degrees compared with those at baseline, however, the IT group recovered more significantly than the LT group. Despite there being no significant difference in SFU grade between the two groups before and after surgery, the reduction of SFU grade in the IT group was more significant than that in the LT group during the 6-, 12- and 24-month follow-up periods. The PL, SFU, and APD were greater in the IT group than in the LT group at 6, 12, and 24 months of follow-up. At 6 months PL was not significantly higher between the two groups, while the outcome was significantly different at 12 months and 24 months.
Immediate laparoscopic pyeloplasty for the infant with severe ureteropelvic junction obstruction is effective, and it can accelerate the recovery of renal morphological indices in infants with severe UPJO-induced hydronephrosis.
婴儿肾盂输尿管连接部梗阻（UPJO）的治疗时机仍存在争议。本研究旨在比较重症UPJO婴儿即刻与延迟腹腔镜肾盂成形术对肾脏形态的恢复效果。
选取2010年至2019年期间在本中心接受腹腔镜肾盂成形术的重症UPJO所致肾积水婴儿，根据手术时年龄分组[即刻治疗（IT）组：出生≤1个月；延迟治疗（LT）组：出生3 - 6个月]。采用超声检查评估肾脏形态，包括肾盂前后径（APD）、实质厚度（PT）、极长（PL）及胎儿泌尿学会（SFU）分级。测量并比较术前及术后6、12和24个月的肾脏形态学结果。
在此期间，共135例患者被分配接受IT（n = 73）或LT（n = 62）治疗并纳入分析。IT组和LT组基线时肾脏形态学指标无显著差异。两组的APD、PT和PL与基线相比均有一定程度恢复，但IT组恢复更显著。尽管两组手术前后SFU分级无显著差异，但在6、12和24个月随访期内，IT组SFU分级降低比LT组更显著。随访6、12和24个月时，IT组的PL、SFU和APD均大于LT组。6个月时两组PL无显著差异，而12个月和24个月时结果有显著差异。
对于重症肾盂输尿管连接部梗阻的婴儿，即刻腹腔镜肾盂成形术有效，可加速重症UPJO所致肾积水婴儿肾脏形态学指标的恢复。
