临床小儿外科杂志
臨床小兒外科雜誌
림상소인외과잡지
JOURNAL OF CLINICAL FEDIATRIC SURGERY
2014年
4期
287-290
,共4页
输尿管梗阻%外科手术%婴儿
輸尿管梗阻%外科手術%嬰兒
수뇨관경조%외과수술%영인
Ureteral Obstruction%Surgical Procedures,Operative%Infant
目的：总结气膀胱输尿管再植术治疗小婴儿输尿管膀胱交界处梗阻的临床经验。方法回顾性分析2006年2月至2013年3月本院收治的19例年龄小于1岁、行气膀胱输尿管再植术的输尿管膀胱交界处梗阻患儿临床资料，并与同期年长儿组32例进行对比。婴儿组单侧12例，双侧7例，22根输尿管行再植，4根行裁剪＋再植；年长儿组单侧25例，双侧7例，30根输尿管行再植，9根行裁剪＋再植。结果所有病例无中转开放手术，无输血。婴儿组手术时间长于年长儿组（P＜0.05），术后泌尿道感染发生率高于年长儿组。年长儿组中1例出现吻合口梗阻急行手术置支撑管，拔管后吻合口引流通畅。共41例患儿获随访，随访率80．4％。B超示输尿管扩张较术前普遍好转；排尿性膀胱尿道造影（VCUG）发现3根输尿管存在低级别反流；除4例术前患肾功能严重受损之外，其余患儿分肾功能维持原有水平或轻度好转。随访情况两组间无明显差别。结论气膀胱输尿管再植术治疗输尿管末端梗阻，在小于1岁的小婴儿病例中手术难度大于年长儿，但通过熟练掌握腹腔镜技术可减少并发症，提高手术安全性，在小婴儿中同样能取得满意疗效。
目的：總結氣膀胱輸尿管再植術治療小嬰兒輸尿管膀胱交界處梗阻的臨床經驗。方法迴顧性分析2006年2月至2013年3月本院收治的19例年齡小于1歲、行氣膀胱輸尿管再植術的輸尿管膀胱交界處梗阻患兒臨床資料，併與同期年長兒組32例進行對比。嬰兒組單側12例，雙側7例，22根輸尿管行再植，4根行裁剪＋再植；年長兒組單側25例，雙側7例，30根輸尿管行再植，9根行裁剪＋再植。結果所有病例無中轉開放手術，無輸血。嬰兒組手術時間長于年長兒組（P＜0.05），術後泌尿道感染髮生率高于年長兒組。年長兒組中1例齣現吻閤口梗阻急行手術置支撐管，拔管後吻閤口引流通暢。共41例患兒穫隨訪，隨訪率80．4％。B超示輸尿管擴張較術前普遍好轉；排尿性膀胱尿道造影（VCUG）髮現3根輸尿管存在低級彆反流；除4例術前患腎功能嚴重受損之外，其餘患兒分腎功能維持原有水平或輕度好轉。隨訪情況兩組間無明顯差彆。結論氣膀胱輸尿管再植術治療輸尿管末耑梗阻，在小于1歲的小嬰兒病例中手術難度大于年長兒，但通過熟練掌握腹腔鏡技術可減少併髮癥，提高手術安全性，在小嬰兒中同樣能取得滿意療效。
목적：총결기방광수뇨관재식술치료소영인수뇨관방광교계처경조적림상경험。방법회고성분석2006년2월지2013년3월본원수치적19례년령소우1세、행기방광수뇨관재식술적수뇨관방광교계처경조환인림상자료，병여동기년장인조32례진행대비。영인조단측12례，쌍측7례，22근수뇨관행재식，4근행재전＋재식；년장인조단측25례，쌍측7례，30근수뇨관행재식，9근행재전＋재식。결과소유병례무중전개방수술，무수혈。영인조수술시간장우년장인조（P＜0.05），술후비뇨도감염발생솔고우년장인조。년장인조중1례출현문합구경조급행수술치지탱관，발관후문합구인류통창。공41례환인획수방，수방솔80．4％。B초시수뇨관확장교술전보편호전；배뇨성방광뇨도조영（VCUG）발현3근수뇨관존재저급별반류；제4례술전환신공능엄중수손지외，기여환인분신공능유지원유수평혹경도호전。수방정황량조간무명현차별。결론기방광수뇨관재식술치료수뇨관말단경조，재소우1세적소영인병례중수술난도대우년장인，단통과숙련장악복강경기술가감소병발증，제고수술안전성，재소영인중동양능취득만의료효。
Objetive To summarize the clinical experience of the pneumovesicoscopy ureteral reimplant-ation operated on infants with vesicoureteral junction obstruction(VUJO). Methods Clinical data of 1 9 cases which were less than 1 years old and had underwent pneumovesicoscopy ureteral reimplantation on VUJO be-tween 2006-02 and 201 3 -03 in our hospital was reviewed.The data were compared with the elder children group of 32 cases.The infantile group was unilateral in 1 2 cases and bilateral in 7 cases while the elder group was unilateral in 25 cases and bilateral in 7 cases. Results No cases were converted to open operation and no cases need blood transfusion.In infantile group,the operative duration were much longer than it was of the eld-er group (P<0.05 ).The complication rate between the 2 groups had no significant difference.41 cases fol-lowed up,most of them have a satisfactory effect. Conclusion Although the operation of infantile group was more difficult,the pneumovesicoscopy ureteral reimplantation can still achieve good results which were similar to the elder children,since skillful laparoscopic technique can reduce the complications and make the operation safe and effective.
