摘要
目的探讨分层次多点悬吊技术在腹腔镜肾盂成形术(laparoscopic pyeloplasty,LP)治疗肾盂输尿管连接部梗阻(ureteropelvic junction obstruction,UPJO)中的应用价值。方法以山东大学齐鲁医院2017年3月至2020年12月期间接受LP治疗的138例单侧UPJO患儿为研究对象,其中男114例,女24例,平均年龄2.9岁(1个月至14岁);左侧98例,右侧40例。术中均采用分层次多点悬吊技术。术后结合超声检查随访评估治疗效果。结果138例患儿均顺利完成手术,手术时间(108.5±27.7)min,术中吻合时间(40.1±6.2)min,出血5~25 mL,术后平均住院时间5.9 d。4例术后发生泌尿系感染,根据尿培养及药敏试验结果予抗炎治疗后好转;1例发生淋巴漏,经延迟拔除腹腔引流管并予对症支持治疗后好转;2例出现血尿,予拔除双J管后症状消失。术后随访6~12个月,所有患儿临床症状消失,复查超声提示肾积水减少或消失,肾皮质不同程度增厚。结论腹腔镜肾盂成形术中应用分层次多点悬吊技术可提供更好的手术视野,降低缝合难度,缩短手术时间,手术效果确切。
Objective To explore the clinical value of hierarchical and multi-point suspension technique during laparoscopic pyeloplasty(LP)for children with congenital ureteropelvic junction obstruction(UPJO).Methods Taking 138 children with UPJO as the resrch object who received LP treatment in Qilu Hospital of Shandeng University from March 2017 to December 2020.The hierarchical and multi-point suspension technique was applied.There were 114 boys and 24 girls with an average age of 34.8(1-168)month.The lesion side was left(n=98)and right(n=40).Postoperative ultrasonic follow-ups were performed for outcome evaluations.Results All operations were successful.Average operative duration was(108.5±27.7)min,intraoperative anastomotic time(40.1±6.2)min,volume of blood loss(5-25)ml and average postoperative hospitalization stay 5.9 days.Four cases of postoperative urinary infection improved after susceptible anti-inflammatory treatment based upon the results of urine culture.One child of lymphatic leakage improved after delayed removal of abdominal drainage tube and symptomatic supports.For two cases of hematuria,symptoms disappeared after removal of double J stent.During a follow-up period of 6 to 12 months,clinical symptoms disappeared and ultrasonic re-examination revealed that hydronephrosis disappeared or decreased,and renal cortex thickened to varying degrees.Conclusion During laparoscopic pyeloplasty,application of hierarchical and multi-point suspension technique offers a better operative field and a satisfactory outcome.It can effectively lower the difficulty of suturing and significantly shorten operative duration.And beginners may master it quickly and easily.
作者
余小芳
刘玮
曹增才
周婷婷
王东明
张强业
王健
李爱武
Yu Xiaofang;Liu Wei;Cao Zengcai;Zhou Tingting;Wang Dongming;Zhang Qiangye;Wang Jian;Li Aiwu(Department of Pediatric Surgery,Qilu Hospital,Shandong University,Jinan 250012,China)
出处
《临床小儿外科杂志》
CAS
CSCD
2022年第4期370-373,共4页
Journal of Clinical Pediatric Surgery
