Kruppa Christian, Wilke Alexandra, Hörz Carola, Kosk Thomas, Hörz Tina, Fitze Guido, Schuchardt Katrin
Department of Pediatric Surgery, University Hospital Dresden, Technical University Dresden, 01307 Dresden, Germany.
J Clin Med. 2023 Aug 31;12(17):5686. doi: 10.3390/jcm12175686.
The minimally invasive implementations of the established open methods for the correction of primary vesicoureteral reflux have proven to be successful in terms of feasibility and safety. The aim of this study was to investigate to what extent pediatric patients benefit from vesicoscopic operations.
Between 2010 and 2022, 224 children (359 ureters) underwent ureteral reimplantation for vesicoureteral reflux in our clinic. Children, operated on according to the COHEN technique, underwent an open approach in 39 cases, whereas 151 patients were operated on vesicoscopically. A total of thirty-four children have received a ureteral reimplantation according to the LEADBETTER-POLITANO technique: twenty-nine openly and five vesicoscopically. The open and vesicoscopic groups were compared with regards to perioperative data and postoperative course.
The mean operating time was significantly shorter for open than for the vesicoscopic procedures in the COHEN group (99 vs. 149 min, < 0.001). Similarly, a comparison of ureteral reimplantations, according to LEADBETTER-POLITANO, favored the open procedure, although this was not significant (161 vs. 196 min, = 0.135). There was no significant difference in the recurrence rate of all the groups. All procedures remained within the accepted range with a success rate of at least 96%. In the postoperative course, a significantly shorter hospital stay (4.1 vs. 7.9 days, < 0.001 for COHEN-patients; 5.6 vs. 9.2 days for LEADBETTER-POLITANO-patients), as well as a significantly lower need for continuous analgesic administration, was observed for the vesicoscopic approaches of both methods (0.8 days in both vesicoscopic groups vs. 3.7 resp. 3.8 days in open groups, < 0.001). In addition, the time of bladder drainage was significantly shorter in open techniques (7.2 vs. 1.9 days, < 0.001 for COHEN-patients; 3 vs. 8.7 days for LEADBETTER-POLITANO-patients).
For almost all underlying causes, the surgical treatment of vesicoureteral reflux can be performed vesicoscopically, even if bilateral, in one session. Patients benefit significantly from the use of minimally invasive surgery in the postoperative course with faster mobilization, less need for analgesics, a shorter bladder drainage and a reduced hospital stay, compared with its open counterparts.
已证实，用于纠正原发性膀胱输尿管反流的传统开放手术的微创实施在可行性和安全性方面是成功的。本研究的目的是调查小儿患者在多大程度上从膀胱镜手术中获益。
2010年至2022年期间，我院224例儿童（359条输尿管）因膀胱输尿管反流接受输尿管再植术。按照科恩技术进行手术的儿童中，39例采用开放手术，而151例患者接受膀胱镜手术。共有34例儿童根据利德贝特 - 波利塔诺技术接受输尿管再植术：29例为开放手术，5例为膀胱镜手术。比较开放手术组和膀胱镜手术组的围手术期数据和术后病程。
在科恩组中，开放手术的平均手术时间明显短于膀胱镜手术（99分钟对149分钟，<0.001）。同样，根据利德贝特 - 波利塔诺技术进行的输尿管再植术比较中，开放手术更具优势，尽管差异不显著（161分钟对196分钟，=0.135）。所有组的复发率无显著差异。所有手术成功率均保持在可接受范围内，至少为96%。在术后病程中，两种方法的膀胱镜手术方式均观察到住院时间显著缩短（科恩组患者为4.1天对7.9天，<0.001；利德贝特 - 波利塔诺组患者为5.6天对9.2天），以及持续镇痛给药需求显著降低（两个膀胱镜手术组均为0.8天，而开放手术组分别为3.7天和3.8天，<0.001）。此外，开放手术技术的膀胱引流时间明显缩短（科恩组患者为7.2天对1.9天，<0.001；利德贝特 - 波利塔诺组患者为3天对8.7天）。
对于几乎所有潜在病因，膀胱输尿管反流的手术治疗即使是双侧的，也可在一次手术中通过膀胱镜进行。与开放手术相比，患者在术后病程中显著受益于微创手术，包括更快的活动恢复、更少的镇痛需求、更短的膀胱引流时间和缩短的住院时间。
