UPJO手术中双J管置入膀胱失败的危险因素分析

目的分析肾盂输尿管连接部梗阻(ureteropelvic junction obstruction,UPJO)患儿双J管置入膀胱失败的危险因素,为选择合适的治疗方法提供依据。方法回顾性收集山西省儿童医院2012年6月至2017年9月因UPJO行离断性肾盂输尿管再吻合术的96例患儿作为研究对象,年龄3个月至12岁,男78例,女18例。左侧60例,右侧23例,双侧13例。依据术中双J管置入成功与否分为成功组(n=74)和失败组(n=22)。结果失败组和成功组输尿管远端狭窄的比例分别是8/22(36.4%)和0/74(0.0%),差异有统计学意义(χ2=29.350,P<0.001)。失败组与成功组合并对侧肾积水的比例分别为7/22(31.8%)和7/74(9.6%),差异有统计学意义(χ2=6.648,P=0.010)。泌尿系统感染史、输尿管操作史、合并肾发育不良和腹痛史在两组间的差异无统计学意义(P>0.05)。结论双J管通过受阻时要考虑输尿管膀胱交界处狭窄,UPJO合并对侧肾积水预示着双J管置入失败的概率增大,治疗上宜选择传统的肾造瘘术。

Analysis of risk factors for failure of double J inserting into bladder during operation of ureteropelvic junction obstruction

Objective To explore the risk factors of failed insertion of double J stent into bladder during operation of ureteropelvic junction obstruction(UPJO)and provide rationales for selecting suitable treatments.Methods Retrospective analysis was performed for 96 cases of dismembered pyeloplasty from June 2012 to September 2017.According to the placing success of double J tube,it was divided into successful group(n=78)and failure group(n=22).There were 78 boys and 18 girls with an age range of 3 months to 12 years.The sideness of hydronephrosis was left(n=60),right(n=23)and bilateral(n=13).Results The proportion of ureteral stenosis was 8/22(36.4%)and 0/74(0%)in failed and successful groups respectively and the difference was statistically significant(χ2=29.350,P<0.001).The failed group and successful combination of contralateral hydronephrosis were 7/22(31.8%)and 7/74(9.6%)respectively(P<0.05)and the difference was statistically significant(χ2=6.648,P=0.010).No statistically significant inter-group difference existed in history of urinary tract infection,history of ureteral operation,history of renal dysplasia,or abdominal pain(P>0.05).Conclusion Stenosis of ureteral bladder junction should be considered in case of a blockage of double J tube.Concurrent contralateral hydronephrosis hints at a higher probability of failed placement of double J stent.Traditional nephrostomy is preferred for treatment.