双J管内引流在小儿肾盂成形术的应用

目的：探讨小儿肾盂成形术中采用双J管内引流的临床效果。方法方便选择该院2013年12月—2015年12月收治的肾盂积水患儿36例,根据引流方式的不同分为两组,其中18例患儿采用外支架管引流+肾造瘘方式引流作为对照组,另18例患儿采用双J管内引流作为观察组,观察两组患儿引流后的临床效果情况。结果36例患儿中,观察组患儿（双J管内引流）的住院时间和支架管取出时间均明显优于对照组患儿（外支架引流）,观察组患儿术后出现1例（5.6%）泌尿系感染明显优于对照组患儿术后出现3例（16.7%）泌尿感染,经抗生素处理后均得以有效控制;差异具有统计学意义（P<0.01）。结论小儿肾盂成形术采用双J管内引流,有效的减少了患儿术后再狭窄,降低了术后并发症的发生,缩短了患儿的住院时间,提高了临床治疗效果,操作简单、使用安全,值得临床推广应用。     

体外修剪输尿管在经腹腔镜离断式成人输尿管狭窄手术中的应用

目的:回顾我院在经腹腔镜下离断式输尿管狭窄手术中近端输尿管体外修剪的方法,分析该方法的可行性及安全性。方法:总结我院自2012年3月—2018年10月行经腹腹腔镜下输尿管狭窄手术患者30例,其中10例采用近端输尿管在体外修剪方式处理,20例采用传统方法体内修剪后完成手术治疗。结果:30例手术均顺利完成,体外组均成功截取病变段,输尿管保留完好,无中转开放手术,平均手术时间(107.9±13.5)min,平均出血量(48.7±3.8)mL,平均住院时间(7.8±1.3)d,短于传统组的(148.0±25.3)min和(9.1±1.5)d,差异有统计学意义。无吻合口瘘,随诊0.5~3年未见吻合口狭窄,肾积水减轻,中度积水2例、轻度积水6例、积水消失2例,肾功能显像均改善,输尿管造影显影良好7例,显影改善3例。结论:在不同的患者行输尿管上段狭窄或肾盂成形术手术中,近端输尿管修剪如在腔镜下难以准确判断病变位置、长度等,可在体外进行修剪,修剪满意后再行还纳继续手术,这样可降低腔内手术难度及准确感知病变情况,为该类手术提供一种安全可行的方法。     

离断性肾盂成形术治疗肾盂输尿管连接部狭窄

目的：探讨肾盂输尿管连接部狭窄的手术治疗方法。方法：采用离断性肾盂成形（Anderson-Hynes术）加肾、输尿管造瘘及内支架引流术治疗肾盂输尿管连接部狭窄48例。结果：一次手术成功47例,二次手术成功1例。近期并发症1例。48例经8个月－6年随访,远期疗效好。结论：先天性肾盂输尿管连接部狭窄,手术文法以离断性Anderson-Hynes术为首选。双J管能起到引流通畅及内支架作用;儿童患者仍需采用肾、输尿管造瘘引流。     

Transperitoneal versus retroperitoneal approaches of pyeloplasty in management of ureteropelvic junction obstruction: A meta-analysis

The aim of this study was to evaluate the benefits and safety of transperitoneal and retroperitoneal pyeloplasty for ureteropelvic junction obstruction by a meta-analysis. We searched the databases including PubMed, Cochrane Library and Embase database from their inception to December 1st, 2020. Relevant literatures comparing retroperitoneal pyeloplasty with transperitoneal pyeloplasty were identified. A meta-analysis was conducted with Revman 5.3. The main outcomes included success rate, operative time, hospital stay, conversion rate of open surgery, overall complications, and detailed postoperative complications/indicators. 15 studies with 1881 patients were included. The results revealed that there were no significant differences between two approaches in success rate [OR = 1.51, 95%CI (0.94, 2.41), p = 0.09], hospital stay [MD = 0.21, 95%CI (?0.12, 0.54), p = 0.21] and overall complications [OR = 1.07, 95%CI (0.76, 1.50), p = 0.69]. The retroperitoneal approach was associated with longer operative time [MD = ?26.91, 95%CI (?40.97, ?12.84), p < 0.001], higher conversion rate [OR = 0.23, 95%CI (0.11, 0.47), p < 0.001] than the transperitoneal approach. As for the detailed postoperative complications/indicators, there were no significant differences between two approaches in the urinary leak, mild hematuria, fever, UPJO recurrence, infection and subcutaneous emphysema, as well as split renal function, renal pelvis anteroposterior diameter. The funnel plots showed that there were no obvious publication biases in our analysis. Therefore, we concluded that transperitoneal and retroperitoneal approaches had similar benefits and safety in success rate, hospital stay, overall complications and detailed postoperative complications/indicators. However, retroperitoneal was associated with longer operative time and higher conversion rate than transperitoneal approach. With the limitations of our study, additional high-quality studies are still essential for further evaluation.