上海交通大学学报（医学版）

上海交通大学学报（医学版）

• 论著（临床研究） • 上一篇    下一篇

肾造瘘后Ⅱ期与Ⅰ期肾盂成形术治疗小婴儿重度肾积水的效果比较

姜大朋 赵骁 耿红全 徐卯升 金龙虎 徐国锋 林厚维 方晓亮 贺雷   

  1. 上海交通大学 医学院附属新华医院小儿外科，上海 200092
  • 出版日期:2016-08-29 发布日期:2016-08-31
  • 通讯作者: 耿红全，电子信箱：ghongquan@hotmail.com。
  • 作者简介:姜大朋（1978—），男，副主任医师，博士；电子信箱：jdp509@163.com。
  • 基金资助:

    上海市教育委员会高峰高原学科建设计划（20152216）

Comparison of clinical efficacy between one-stage pyeloplasty and second-stage pyeloplasty after nephrostomy for the treatment of severe hydronephrosis in infants

JIANG Da-peng, ZHAO Xiao, GENG Hong-quan, XU Mao-sheng, JIN Long-hu, XU Guo-feng, LIN Hou-wei, FANG Xiao-liang, HE Lei   

  1. Department of Pediatric Surgery, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200092, China
  • Online:2016-08-29 Published:2016-08-31
  • Supported by:

    Shanghai Municipal Education Commission—Gaofeng Clinical Medicine Grant Support，20152216

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摘要：

目的·探讨分期肾盂成形术（先期肾造瘘）与不分期肾盂成形术治疗小于3个月重度肾积水患儿的临床效果。方法·回顾性分析上海交通大学医学院附属新华医院2012年1月—2015年7月接受手术治疗的小于3个月重度肾积水患儿的临床资料。25例行分期肾盂成形术（Ａ组），39例行不分期肾盂成形术（Ｂ组）。比较2组手术时间、术中出血量、并发症发生率、总住院时间及术后肾积水恢复情况等。结果·共有64例小于3个月重度肾积水患儿纳入研究。Ａ组手术时间、总住院时间、术后尿路感染发生率明显高于Ｂ组，分别为（81±20） min与（53±18） min、（11.6±2.6） d与（6.2±1.5） d、36.0%与17.9%。术后6个月，2组患儿肾积水程度和肾脏功能均得到显著改善，组间差异无统计学意义。结论·分期肾盂成形术对于小于3月龄重度积水患儿肾脏的最终形态、功能恢复没有明显优势；不分期肾盂成形术安全、有效，应作为小婴儿重度肾积水的首选治疗方式。

关键词: 肾积水, 肾盂成形术, 肾造瘘

Abstract:

Objective · To investigate the clinical efficacy of one-stage pyeloplasty and second-stage pyeloplasty after nephrostomy for the treatment of severe hydronephrosis in infants younger than 3 months. Methods · Clinical data of severe hydronephrosis infants younger than 3 months who underwent pyeloplasty at Xinhua Hospital affiliated to the Shanghai Jiao Tong University School of Medicine from Jan. 2012 to Jul. 2015 were retrospectively analyzed. Twenty-five patients received second-stage pyeloplasty after nephrostomy (the A group) and 39 patients received one-stage pyeloplasty (the B group). The operative time, intraoperative blood loss, incidence rate of complications, hospital stay, and postoperative recovery were compared between two groups. Results · Sixty-four severe hydronephrosis infants younger than 3 months were enrolled. The A group has longer operative time and hospital stay and higher incidence rate of postoperative urinary tract infection as compared with the B group [(81 ± 20) min vs (53 ± 18) min, (11.6 ± 2.6) dvs (6.2 ± 1.5) d, and 36.0% vs 17.9%), respectively]. The hydronephrosis and renal function in two groups were significantly improved 6 months after surgery and the difference between two groups was not statistically significant. Conclusion · Second-stage pyeloplasty after nephrostomy has no obvious advantage for the treatment of severe hydronephrosis in infants younger than 3 months with respect to the final morphology and function recovery of involved kidneys. One-stage pyeloplasty is safe and effective and should be served as the preferred method for the treatment of severe hydronephrosis in infants.

Key words: hydronephrosis, pyeloplasty, nephrostomy