摘要
目的评价开放与气膀胱腹腔镜下膀胱输尿管再植术治疗儿童膀胱输尿管反流的临床效果。方法回顾性分析2004年12月至2010年10月收治108例膀胱输尿管反流患儿资料，按手术方式分为开放手术组（37例）和气膀胱腹腔镜手术组（71例）。比较2组手术时间、术后静脉使用抗生素时间及留置导尿时间、术后住院时间、总费用及手术费用，气膀胱腹腔镜组前后期的手术时间及后期手术时间与开放手术时间。结果气膀胱组与开放组术后住院天数分别为（6．8±1．9）、（8．9±2．9）d（P=0．002），术后保留导尿时间分别为（5．2±1．2）、（6．2±2．2）d（P=0．057），术后静脉使用抗生素时间分别为（5．0±1．3）、（5．4±1．6）h（P=0．159），总住院费用分别为（16067．9±4295．8）元、（15617．7±5486．5）元（P=0．168），手术费用分别为（9369．4±1366．6）、（7397．9±1797．3）元（P=0．083）。气膀胱组前后期平均手术时间分别为3．6、2．8h（P=0．286），后期与开放组时间（2．3h）接近（P=0．234）。两组均无明显术中、术后近期并发症。气膀胱组随访24例，随访时间5～72个月，平均22个月，38侧排泄性膀胱尿道造影（MCU），3例反流复发，其中2例由3级降为1级，1例由5级降为3级。开放组随访5例，随访时间4～32个月，平均18个月，9侧MCU，发现膀胱憩室1例，1例术后6个月出现梗阻，再次手术后好转。结论气膀胱腹腔镜下手术治疗儿童膀胱输尿管反流住院时间短、导尿时间短，是一种安全有效的手术方式。
Objective To compare the clinical results of the ureteral reimplantation with the traditional open approach and laparoscopic pneumovesical approach. Methods A retrospective review of 108 patients who underwent ureteral reimplantation from December 2004 to October 2010 was conducted. The patients were divided into open and pneumovesical groups according to the surgical approach. Perioperative results were compared between the two groups in terms of operative time, postoperative intravenous antibiotics duration, catheterization duration, postoperative stay, average total cost and surgical cost, respectively. And the pneumovesical group was divided into two stages by time, compared the operative time of the two stages and between the later stage and the open group. Results The postoperative hospital stay of pneumovesical group was shorter than the open group （6.8 ±1.9 d and 8.9 ± 2.9 d, P = 0. 002）. For catheterization duration, the pneumovesical group was shorter than the open group as well （5.2 ± 1.2 d and 6.2 ± 2.2 d, P = 0. 057）. For the postoperative intravenous antibiotics duration, the pneumovesical group was 5.0 4- 1.3 h, the open group was 5.4 ~ 1.6 h （P =0. 159）. For the total cost, the pneumovesical group was 16 067.9 ± 4 295.8 RMB, the open group was 15 617.7± 5 486.5 RMB （P = 0. 168）. For the surgical cost, the pneumovesical group was 9369.4 ± 1366.6 RMB, the open group was 7397.9 ± 1797.3 RMB （ P = 0. 083 ）. Operative duration of the pneumovesical group and open group were 3. 2 ± 1. 1 h and 2. 3 ± 1. 1 h （P =0. 003）. For pneumovesical group, the mean operative durations of the two stages were 3.6 h and 2.8 h （P = 0. 286）. And the later stage of pneumovesical group was a little longer than the open group, but no significant difference （P = 0. 234）. No major complication was found in the 2 groups during the operative time and the postoperative hospital stay. Twenty-four patients （38 ureters） of the pneumovesical group were followed up with micturating cystourethrography （MCU） , ureterovesical reflux recurred in 3 patients. Two patients changed from grade Ⅲ to grade I and 1 patient changed from grade Ⅴ to grade Ⅲ after the surgery. Five patients （9 ureters） of the open group were followed up, 1 patient found bladder diverticulum; 1 patient found ureteral stricture 6 months after the surgery and got improved after secondary ureteral relimplantation surgery. Conclusions The pneumovesical approach is shorter than the open group in postoperative hospital stay and catheterization reserved duration. The pneumovesical approach is a safe and effective option for ureteral reimplantation.
出处
《中华泌尿外科杂志》
CAS
CSCD
北大核心
2012年第6期439-442,共4页
Chinese Journal of Urology
