離斷式腎盂輸尿管成形術(shù)后應(yīng)用兩種引流方式的對照分析
發(fā)布時間：2018-12-27 13:54
【摘要】：背景先天性腎積水是小兒泌尿外科較為常見的疾病,發(fā)病率占新生兒的1%~2%。腎積水患兒產(chǎn)前彩超均提示腎積水,一般來說,胎兒的泌尿生殖系統(tǒng)會隨著孕婦妊娠周期的增加而逐漸成熟,一些新生兒中,輕度腎積水可能會自行消退,腎功能得到改善,但部分中、重度腎積水患兒如得不到及時診治可能會導(dǎo)致腎功能損害,嚴(yán)重時出現(xiàn)腎功能衰竭[1、2]。因此,腎積水患兒應(yīng)定期隨訪,及時手術(shù),以免延誤患兒病情。小兒先天性腎積水的手術(shù)治療原則首選離斷式腎盂輸尿管成形術(shù),手術(shù)切除影響腎盂積水的原因,進(jìn)而達(dá)到緩解患兒腎積水的目的。術(shù)后常規(guī)留置引流管引流尿液,避免術(shù)后出現(xiàn)輸尿管狹窄至再次腎積水可能。目前常用內(nèi)引流和外引流兩種方法,本文通過分析比較腎積水術(shù)后兩種引流方法的手術(shù)和住院時間、術(shù)中出血量、并發(fā)癥以及術(shù)后隨訪情況來探討兩種引流方式的優(yōu)缺點。目的探討雙J管內(nèi)引流和外引流兩種方式在腎積水術(shù)后應(yīng)用的優(yōu)缺點。方法收集我院2013年1月-2016年1月收治的腎積水患兒的臨床資料,共62例,男50例,女12例,年齡范圍在1月~12歲,平均年齡2.54歲;左側(cè)40例,右側(cè)22例;根據(jù)術(shù)后引流方式分為內(nèi)引流組(雙J管、腎周引流管)36例,男28例,女8例;左側(cè)24例,右側(cè)12例;外引流組(腎盂引流管、輸尿管支架管、腎周引流管)26例,男22例,女4例;左側(cè)16例,右側(cè)10例。根據(jù)胎兒泌尿外科協(xié)會腎積水分級(society of fetal urology grading system)標(biāo)準(zhǔn),腎積水手術(shù)指征為集合區(qū)分離(antero-posterio,AP)20mm,且伴有腎盞擴(kuò)張者。其中內(nèi)引流組輕度0例,中度1例,重度35例;外引流組輕度0例,中度5例,重度21例。全部手術(shù)病例均伴腎盞擴(kuò)張;術(shù)后病理結(jié)果均證實為輸尿管連接處梗阻。比較兩組一般情況、手術(shù)時間、住院時間、術(shù)中出血量和術(shù)后并發(fā)癥以及隨訪腎積水術(shù)后的恢復(fù)情況。對兩組療效進(jìn)行評估,并進(jìn)行統(tǒng)計學(xué)分析。結(jié)果1、兩組在年齡、性別、側(cè)別上對比差異無統(tǒng)計學(xué)意義(P0.05)。2、內(nèi)引流組手術(shù)時間平均為75.83±12.50min;術(shù)中出血量平均為11.89±8.26ml,平均住院時間為13.75±5.22d,泌尿系感染1例,術(shù)后3天腹痛2例,吻合口狹窄2例,結(jié)石1例,術(shù)后血尿時間為2.67±2.04d。3、外引流組手術(shù)時間平均為93.46±19.17min;術(shù)中出血量平均為15.15±13.86ml,平均住院時間為22.27±6.90d,泌尿系感染3例,術(shù)后3天腹痛8例,吻合口狹窄2例,結(jié)石0例,術(shù)后血尿時間為2.65±1.77d。4、兩組在手術(shù)時間、住院時間和術(shù)后并發(fā)癥總發(fā)生率上相比差異有統(tǒng)計學(xué)意義(P0.05);在術(shù)中出血量、術(shù)后血尿、泌尿系感染、結(jié)石等單方面相比,差異無統(tǒng)計學(xué)意義(P0.05)。結(jié)論離斷式腎盂輸尿管成形術(shù)后雙J管內(nèi)引流縮短了手術(shù)和住院時間,減少了術(shù)后并發(fā)癥。
[Abstract]:Background congenital hydronephrosis is a common disease in pediatric urology. In general, the fetal genitourinary system matures gradually with the increase of pregnant women's pregnancy cycle. In some newborns, mild hydronephrosis may recede and renal function can be improved. But in some cases, severe hydronephrosis may lead to renal dysfunction without timely diagnosis and treatment, and renal failure may occur in severe cases. Therefore, hydronephrosis children should be regularly followed up, timely surgery, so as not to delay the condition of children. The principle of surgical treatment for congenital hydronephrosis in children is the first choice of dissociated ureteropelvic angioplasty. Surgical resection of hydronephrosis affects the causes of hydronephrosis so as to alleviate the hydronephrosis in children. After operation, the drainage tube was used to drain urine to avoid ureteral stricture to rehydronephrosis. At present, there are two kinds of drainage methods: internal drainage and external drainage. The advantages and disadvantages of the two drainage methods were discussed by comparing the operation and hospitalization time, intraoperative bleeding volume, complications and postoperative follow-up of the two drainage methods after hydronephrosis. Objective to investigate the advantages and disadvantages of double J tube internal drainage and external drainage in postoperative hydronephrosis. Methods the clinical data of 62 children with hydronephrosis from January 2013 to January 2016 were collected. There were 50 males and 12 females, with an average age of 2.54 years, 40 cases on the left and 22 cases on the right. According to the postoperative drainage mode, 36 cases were divided into two groups (double J tube, perirenal drainage tube), male 28 cases, female 8 cases, left 24 cases, right 12 cases, left side 24 cases, right 12 cases, left 24 cases, right 12 cases. 26 cases (22 males, 4 females) in the external drainage group (renal pelvis drainage tube, ureteral stent tube, perirenal drainage tube), left 16 cases, right 10 cases. According to the (society of fetal urology grading system) standard of hydronephrosis grade of fetal urology association, hydronephrosis was characterized by separation of collecting area (antero-posterio,AP) 20 mm, and accompanied by dilatation of renal calyceal. There were 0 mild cases, 1 moderate case and 35 severe cases in the internal drainage group, while in the external drainage group, there were 0 mild cases, 5 moderate cases and 21 severe cases. All cases were accompanied by renal calcaneal dilatation, and the postoperative pathological results were confirmed as ureteral junction obstruction. The general condition, operation time, hospital stay, intraoperative bleeding and postoperative complications were compared between the two groups, and the recovery of hydronephrosis was followed up. The curative effect of the two groups was evaluated and statistically analyzed. Results 1. There was no significant difference in age, sex and side sex between the two groups (P0.05). The average operative time of the internal drainage group was 75.83 鹵12.50 min. The average amount of blood loss during operation was 11.89 鹵8.26 ml, the average hospital stay was 13.75 鹵5.22 days, urinary tract infection occurred in 1 case, abdominal pain in 2 cases, anastomotic stricture in 2 cases, stone in 1 case, postoperative hematuria time was 2.67 鹵2.04d.3. The average operative time of external drainage group was 93.46 鹵19.17 min. The average amount of blood loss during operation was 15.15 鹵13.86 ml, the average hospital stay was 22.27 鹵6.90 days, urinary tract infection occurred in 3 cases, abdominal pain in 8 cases, anastomotic stenosis in 2 cases, stone in 0 cases, and hematuria time was 2.65 鹵1.77 d.4. There were significant differences between the two groups in the operation time, hospital stay and the total incidence of postoperative complications (P0.05). There was no significant difference in intraoperative bleeding, postoperative hematuria, urinary tract infection, stone and other unilateral differences (P0.05). Conclusion double J tube drainage can shorten the operation and hospitalization time and reduce postoperative complications.
【學(xué)位授予單位】：新鄉(xiāng)醫(yī)學(xué)院
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R726.9
[Abstract]:Background congenital hydronephrosis is a common disease in pediatric urology. In general, the fetal genitourinary system matures gradually with the increase of pregnant women's pregnancy cycle. In some newborns, mild hydronephrosis may recede and renal function can be improved. But in some cases, severe hydronephrosis may lead to renal dysfunction without timely diagnosis and treatment, and renal failure may occur in severe cases. Therefore, hydronephrosis children should be regularly followed up, timely surgery, so as not to delay the condition of children. The principle of surgical treatment for congenital hydronephrosis in children is the first choice of dissociated ureteropelvic angioplasty. Surgical resection of hydronephrosis affects the causes of hydronephrosis so as to alleviate the hydronephrosis in children. After operation, the drainage tube was used to drain urine to avoid ureteral stricture to rehydronephrosis. At present, there are two kinds of drainage methods: internal drainage and external drainage. The advantages and disadvantages of the two drainage methods were discussed by comparing the operation and hospitalization time, intraoperative bleeding volume, complications and postoperative follow-up of the two drainage methods after hydronephrosis. Objective to investigate the advantages and disadvantages of double J tube internal drainage and external drainage in postoperative hydronephrosis. Methods the clinical data of 62 children with hydronephrosis from January 2013 to January 2016 were collected. There were 50 males and 12 females, with an average age of 2.54 years, 40 cases on the left and 22 cases on the right. According to the postoperative drainage mode, 36 cases were divided into two groups (double J tube, perirenal drainage tube), male 28 cases, female 8 cases, left 24 cases, right 12 cases, left side 24 cases, right 12 cases, left 24 cases, right 12 cases. 26 cases (22 males, 4 females) in the external drainage group (renal pelvis drainage tube, ureteral stent tube, perirenal drainage tube), left 16 cases, right 10 cases. According to the (society of fetal urology grading system) standard of hydronephrosis grade of fetal urology association, hydronephrosis was characterized by separation of collecting area (antero-posterio,AP) 20 mm, and accompanied by dilatation of renal calyceal. There were 0 mild cases, 1 moderate case and 35 severe cases in the internal drainage group, while in the external drainage group, there were 0 mild cases, 5 moderate cases and 21 severe cases. All cases were accompanied by renal calcaneal dilatation, and the postoperative pathological results were confirmed as ureteral junction obstruction. The general condition, operation time, hospital stay, intraoperative bleeding and postoperative complications were compared between the two groups, and the recovery of hydronephrosis was followed up. The curative effect of the two groups was evaluated and statistically analyzed. Results 1. There was no significant difference in age, sex and side sex between the two groups (P0.05). The average operative time of the internal drainage group was 75.83 鹵12.50 min. The average amount of blood loss during operation was 11.89 鹵8.26 ml, the average hospital stay was 13.75 鹵5.22 days, urinary tract infection occurred in 1 case, abdominal pain in 2 cases, anastomotic stricture in 2 cases, stone in 1 case, postoperative hematuria time was 2.67 鹵2.04d.3. The average operative time of external drainage group was 93.46 鹵19.17 min. The average amount of blood loss during operation was 15.15 鹵13.86 ml, the average hospital stay was 22.27 鹵6.90 days, urinary tract infection occurred in 3 cases, abdominal pain in 8 cases, anastomotic stenosis in 2 cases, stone in 0 cases, and hematuria time was 2.65 鹵1.77 d.4. There were significant differences between the two groups in the operation time, hospital stay and the total incidence of postoperative complications (P0.05). There was no significant difference in intraoperative bleeding, postoperative hematuria, urinary tract infection, stone and other unilateral differences (P0.05). Conclusion double J tube drainage can shorten the operation and hospitalization time and reduce postoperative complications.
【學(xué)位授予單位】：新鄉(xiāng)醫(yī)學(xué)院
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R726.9
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