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目的探讨微小切口离断性肾盂成形术治疗婴儿先天性肾积水的有效性和安全性。方法回顾性分析2010年5月至2015年6月本院收治的90例1岁以下先天性单侧婴儿肾积水患者临床资料,患儿年龄1~12个月,平均年龄(5.98±2.87)个月,经B超确诊肾盂扩张大于3 cm,有不明原因的哭闹、腹痛等临床症状,观察3个月,静脉肾盂造影与CTU检查支持肾盂输尿管交界处不全梗阻(PUJO)。于术后3个月、6个月、12个月随访。我们将本研究中的手术时间、并发症和手术成功率和文献报道的腹腔镜手术治疗同龄婴儿肾积水数据进行比较。结果 90例手术均获成功,无因切口较小需扩大切口进行手术病例,平均手术时间显著少于文献报道的同龄婴儿腹腔镜手术时间(91.2±9.4)min vs(178.5±9.1)min,P<0.01。4例术后出现尿路感染。而文献报道病例组7例出现手术并发症(尿路感染3例,局部出血1例,肾盂输尿管吻合口尿瘘1例,其他2例),3例术后肾盂输尿管连接处梗阻复发,手术失败。本组手术和文献中腹腔镜下肾盂成形术相比,在手术成功率、术后并发症方面无明显差别。结论微小切口离断性肾盂成形术尤其适用于治疗1岁以下婴儿肾积水,值得临床推广。
Objective To investigate the effectiveness and safety of mini-incision pyeloplasty in the treatment of congenital hydronephrosis in infants. Methods The clinical data of 90 patients with congenital unilateral infantile hydronephrosis under 1 year of age from May 2010 to June 2015 were retrospectively analyzed. The mean age was 5.98 ± 2.87, Months, the diagnosis of pyelonephritis by B ultrasound is greater than 3 cm, with unexplained crying, abdominal pain and other clinical symptoms observed for 3 months, intravenous pyelography and CTU examination support the ureteropelvic junction obstruction (PUJO). After 3 months, 6 months, 12 months follow-up. We compared operative time, complications, and surgical success rates in this study with those reported in the literature for laparoscopic surgery for infantile hydronephrosis of the same age. Results All the 90 surgeries were successful. No incision was required because of the smaller incision. The mean operative time was significantly shorter than that of the same age group (91.2 ± 9.4) min vs (178.5 ± 9.1) min, P <0.01.4 cases of urinary tract infection. In the reported cases, there were 7 cases of operative complications (urinary tract infection in 3 cases, local bleeding in 1 case, ureteropelvic anastomotic urinary fistula in 1 case, the other 2 cases), and 3 cases of postoperative ureteropelvic junction obstruction recurrence, the operation failed. This group of surgery and literature laparoscopic pyeloplasty compared to the success rate of surgery, postoperative complications no significant difference. Conclusion Small incision pyeloplasty is especially suitable for the treatment of hydronephrosis in infants younger than 1 year, which is worthy of clinical promotion.