【摘要】：研究背景腎積水,是一種較多見的小兒泌尿系統(tǒng)先天性畸形。臨床上有近90%的腎積水是由UPJ0(腎盂輸尿管連接處梗阻)引起的。小兒腎積水的治療方式包括保守治療和手術(shù)治療,而手術(shù)治療方式應(yīng)用最多的是Anderson-Hynes(離斷式腎盂成形術(shù))術(shù)式,該術(shù)式一經(jīng)出現(xiàn)就立即成為了腎積水治療的標(biāo)準(zhǔn)術(shù)式。開放腎盂離斷式成形術(shù)治療腎盂輸尿管連接處梗阻一次性成功率可達(dá)到90%以上。而文獻(xiàn)報道后腹腔鏡術(shù)式治療小兒腎積水的一次性成功率和開放術(shù)式相當(dāng)。但后腹腔鏡途徑仍然存在著手術(shù)空間小、不太適用于治療復(fù)雜或再次手術(shù)的腎積水患兒、術(shù)后手術(shù)瘢痕仍較明顯的缺點。目的本研究旨在探討經(jīng)腹三通道腹腔鏡下離斷式腎盂成形術(shù)治療小兒腎積水的臨床療效及預(yù)后,并比較其和后腹腔鏡途徑的優(yōu)缺點,探討該手術(shù)方式用于治療由UPJ0引起的小兒腎積水的臨床應(yīng)用價值。方法選取本中心2013年9月至2015年4月經(jīng)超聲、MRU檢查確診為由UPJ0引起的單側(cè)重度腎積水患兒59例,隨訪時間為6-12個月。分為實驗組和對照組:實驗組(經(jīng)臍三通道腹腔鏡途徑34例),對照組(后腹腔鏡途徑25例)。收集實驗組和對照組兩組患兒性別、手術(shù)年齡和患腎部位、手術(shù)時間、術(shù)中出血量、術(shù)中有無更改手術(shù)方式、平均住院日、術(shù)前和術(shù)后的腎盂前后徑、GFR(腎小球濾過率)等手術(shù)相關(guān)資料。并對兩組記錄的數(shù)據(jù)進(jìn)行統(tǒng)計學(xué)分析。結(jié)果兩組患兒手術(shù)均順利完成,術(shù)中未更改開放手術(shù),無嚴(yán)重手術(shù)并發(fā)癥狀,無死亡病例,兩組各有1例患兒術(shù)后復(fù)查提示再次梗阻,再次手術(shù)后未再出現(xiàn)梗阻,遂這2例患兒的數(shù)據(jù)采用的是第2次手術(shù)的數(shù)據(jù)。隨訪時間為6-12個月。實驗組和對照組組內(nèi)腎盂前后徑和腎小球濾過率兩指標(biāo)手術(shù)前后的數(shù)據(jù)做兩樣本配對樣本t檢驗,各P值均小于0.05,表明兩組組內(nèi)手術(shù)前后有明顯差異,兩種途徑手術(shù)療效肯定。最后,分別將兩組內(nèi)數(shù)據(jù)差值差做兩配對樣本t檢驗,檢驗結(jié)果顯示所有指標(biāo)治療前后均無統(tǒng)計學(xué)差異(P0.05)。表明兩種手術(shù)途徑治療由UPJ0引起的小兒重度腎積水的療效無顯著差別,療效相當(dāng)。結(jié)論經(jīng)臍三通道腹腔鏡下離斷式腎盂成形術(shù)手術(shù)療效與后腹腔鏡途徑相當(dāng),而手術(shù)空間更大,對于二次或者多次手術(shù)的患兒優(yōu)勢更加明顯,術(shù)后傷口瘢痕不明顯,美容效果更佳,具有較大的臨床應(yīng)用價值。
[Abstract]:Background hydronephrosis is a common congenital malformation of urinary system in children. Nearly 90% of hydronephrosis is caused by UPJ0 (ureteropelvic junction obstruction). The treatment of hydronephrosis in children includes conservative treatment and surgical treatment. Anderson-Hynes (dissected pyeloplasty) is the most commonly used surgical treatment, which has become the standard procedure for hydronephrosis as soon as it appears. The one-time success rate of open pyeloplasty for ureteropelvic junction obstruction was more than 90%. The one-time success rate of posterior laparoscopy in the treatment of hydronephrosis in children is the same as that of open operation. However, retrolaparoscopic approach still has small operative space, which is not suitable for the treatment of complicated or re-operated hydronephrosis in children, and postoperative scar is still obvious shortcomings. Objective to investigate the clinical efficacy and prognosis of three-channel laparoscopic pyeloplasty in children with hydronephrosis, and to compare its advantages and disadvantages with that of retroperitoneal laparoscopic approach. To evaluate the clinical value of this method in the treatment of hydronephrosis caused by UPJ0 in children. Methods from September 2013 to April 2015, 59 children with unilateral severe hydronephrosis diagnosed by MRU were selected. The follow-up period was 6 months and 12 months. They were divided into experimental group (n = 34) and control group (n = 25). The sex, the age of operation, the location of the kidney, the time of operation, the amount of bleeding during the operation, the average length of hospitalization, the anterior and posterior diameter of renal pelvis before and after operation were collected in the experimental group and the control group, and whether there were any changes in the operation mode during the operation. GFR (glomerular filtration rate) and other surgical data. The data recorded in the two groups were analyzed statistically. Results the operation was successfully completed in the two groups. The open operation was not changed during the operation. There were no serious complications and no death cases in the two groups. One case in each group showed re-obstruction after operation, and there was no further obstruction after the re-operation. The data of the two cases were based on the data of the second operation. The follow-up period was 6 to 12 months. The pre-and post-operative data of renal pelvis diameter and glomerular filtration rate in the experimental group and the control group were tested by paired sample t test with two samples, each P < 0.05, indicating that there was a significant difference between the two groups before and after the operation, and that there was a significant difference between the two groups before and after the operation. The curative effect of the two approaches is definite. Finally, the difference of data between the two groups was matched by two pairs of t-test, the results showed that there was no statistical difference before and after treatment (P0.05). The results showed that there was no significant difference between the two surgical approaches in the treatment of severe hydronephrosis caused by UPJ0. Conclusion the curative effect of three-channel laparoscopic disconnection pyeloplasty is similar to that of retroperitoneal laparoscopy, but the operation space is larger, the advantage is more obvious for the second or multiple operations in children, and the wound scar is not obvious after operation, and the curative effect is similar to that of retroperitoneal laparoscopic pyeloplasty. The cosmetic effect is better and has great clinical application value.
【學(xué)位授予單位】：南方醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R726.9

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