摘要
目的：探讨腹腔镜Cohen及改良Glenn－Anderson输尿管膀胱再植术治疗儿童输尿管膀胱连接部畸形的临床效果。方法回顾性分析我院2005年12月～2012年2月输尿管膀胱连接处疾病96例资料。前30例行Cohen术，后66例行改良Glenn－Anderson术。术后随访1年，比较2组手术时间、出血量、术后住院时间、并发症及术后输尿管积水恢复情况。结果2组各有1例中转开放手术，其余腹腔镜完成手术者2组手术时间[（129±30）min vs．（139±42）min，t＝－1．177，P＝0．242]，术中出血量[（17．9±10．4）ml vs．（18．6±10．5）ml，t＝－0．266，P＝0．791]，术后住院时间[（9．5±1．4）d vs．（9．2±1．4）d，t＝0．941，P＝0．349]差异均无显著性。 Cohen组1例术中皮下气肿，1例术后反复尿路感染，改良Glenn－Anderson组1例膀胱穿刺孔出血，2组并发症发生率差异无显著性（χ2＝0．533，P＝0．465）。术后1年Cohen组随访30例33根输尿管，改良Glenn－Anderson组随访53例57根输尿管，均无积水加重病例，改良Glenn－Anderson组输尿管恢复较Cohen组更好（恢复正常、缩小、无缓解分别为54、3、0侧和21、9、3侧，Z＝－3．842，P＝0．000），肾积水恢复情况2组差异无显著性（Z＝－0．121，P＝0．904）。结论腹腔镜下Cohen及改良Glenn－Anderson术式都具有安全有效、容易学习、具有微创优势的特点，后者输尿管直径缩小更明显。
Objective To describe the clinical efficacy of laparoscopic modified Glenn-Anderson and Cohen ureteric reimplantation for congenital malformation of vesicoureteral junction in children. Methods A retrospective review of 96 patients who underwent ureteric reimplantation from December 2005 to February 2012 was conducted.The first 30 cases were given Cohen procedure, while the remaining 66 cases underwent modified Glenn-Anderson procedure. The follow-up period was 1 year. Comparisons in terms of operative duration, blood loss, hospital stay, complication rate, and therapeutic efficacy were made. Results Both groups had 1 patient requiring a conversion to open procedure.No significant differences were found in operative time [（129 ±30） min vs.（139 ±42） min, t=-1.177, P=0.242], blood loss [（17.9 ±10.4） ml vs.（18.6 ±10.5） ml, t=-0.266, P=0.791], and hospital stay [（9.5 ±1.4） d vs.（9.2 ±1.4） d, t=0.941, P=0.349] between the two groups. Postoperative complications included 1 case of transient subcutaneous emphysema and 1 case of urinary tract infection in the Cohen group and 1 case of bladder port side bleeding in the modified Glenn-Anderson group.No significant difference was found in complication rates （χ2 =0.533, P=0.465）.Follow-up examinations were conducted in 30 patients （33 ureters） in the Cohen group and in 53 patients （57 ureters） in the modified Glenn-Anderson group.Significant differences were found in the remission of the ureter between the modified Glenn-Anderson group and the Cohen group （ achieving a normal diameter, a shorter diameter and unconspicuous change were 54 ureters, 3 ureters, 0 ureters in the modified Glenn-Anderson group, and 21 ureters, 9 ureters, 3 ureters in the Cohen group, Z=-3.842, P=0.000）.No significant differences were found in the remission of hydronephrosis （ Z=-0.121, P=0.904） . Conclusions Both of the procedures are safe and effective options for congenital malformation of vesicoureteral junction in children.The modified Glenn-And
出处
《中国微创外科杂志》
CSCD
北大核心
2015年第1期36-39,共4页
Chinese Journal of Minimally Invasive Surgery
基金
国家临床重点专科建设项目资助(国卫办医函【2013】544)
关键词
输尿管畸形
腹腔镜手术
Ureteral malformation；Laparoscopic surgery
