Clinical efficacy of gas-bladder laparoscopic Politano-Leadbetter for congenital malformation of vesicoureteral junction in children
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摘要: 目的 比较气膀胱下Politano-Leadbetter与Cohen输尿管再植术治疗小儿膀胱输尿管连接部异常的临床疗效。方法 回顾性分析我院2016年1月—2020年3月收治的51例膀胱输尿管连接部异常的患儿，早期24例行Cohen术式，后期27例采用Politano-Leadbetter术，术后随访6个月~3年，比较2组手术时长、术中出血量、术后住院时间、并发症及术后输尿管扩张恢复情况。结果 51例患儿均在气膀胱下顺利完成手术，无一例中转开腹，2组手术时间[(114.42±29.84) min vs (129.59±47.42) min，P=0.18]、术中出血量[(5.88±4.81) mL vs (5.81±4.25) mL，P=0.96]、术后住院时间[(10.17±2.65) d vs (10.56±3.23) d，P=0.64]比较差异无统计学意义；所有患儿拔除尿管后排尿通畅，无尿漏。2组患儿各有2例术后出现尿路感染1次，2组并发症发生率差异无统计学意义(P=0.32)。术后1、3、6个月定期复查泌尿系超声，2组患儿术后输尿管扩张情况均较术前好转，48例完全恢复，3例部分恢复；其中Cohen组2例，Politano-Leadbetter组1例，术前均为巨输尿管，术后6个月复查排尿性膀胱泌尿道造影(VCUG)均未见反流，2组输尿管恢复情况差异无统计学意义(P=0.59)。结论 气膀胱下Politano-Leadbetter术治疗小儿膀胱输尿管连接部异常的临床疗效确切、安全有效，具有微创优势的特点；同时Politano-Leadbetter术的输尿管符合自然生理解剖特点，在输尿管游离范围、裁剪及黏膜下隧道长度方面具有Cohen术所不具备的优势，值得临床推广。Abstract: Objective To compare the clinical efficacy between laparoscopic Politano-Leadbetter and Cohen ureteric reimplantation for congenital malformation of vesicoureteral junction in children.Methods A retrospective analysis of 51 patients who underwent ureteric reimplantation from January 2016 to March 2020 was conducted. The first 24 cases were given Cohen procedure, while the remaining 27 cases underwent Politano-Leadbetter procedure. The follow-up period was 6 months to 3 years. Comparisons in terms of operative duration, blood loss, hospital stay, complication rate and postoperative ureteral dilatation were made.Results All 51 cases underwent ureteric reimplantation successfully, and none of them were transferred to open surgery. No significant differences were found in operation time ([114.42±29.84] min vs [129.59±47.42]min, P=0.18), blood loss ([5.88±4.81] mL vs [5.81±4.25] mL, P=0.96), hospital stay ([10.17±2.65] d vs [10.56±3.23] d, P=0.64) between the groups. All children had no obstructed urination or urinary leakage after removing the catheter. There was no significant difference in the incidence of complications between the two groups (P=0.32). After 1 month, 3 months, 6 months, ureteral dilatation of 48 cases recovered completely and 3 cases partially recovered. Among the two groups, there was no significant difference in ureteral recovery (P=0.59).Conclusion The procedure of Politano-Leadbetter is an effective and safe option for congenital malformation of vesicoureteral junction in children. The operation has the characteristics of minimally invasive advantages. Compared with Cohen, Politano-Leadbetter is easier to operate in terms of natural physiological anatomy, so it is worthy of clinical promotion.
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表 1 2组一般资料比较
例，X±S 组别 性别 年龄/月 病种 双侧病变 输尿管平均最大直径/mm 男 女 原发性膀胱输尿管反流 膀胱输尿管连接部狭窄 是 否 A组(24例) 17 7 15.54±9.07 19 5 7 17 11.44±6.25 B组(27例) 16 11 20.29±12.66 20 7 8 19 11.18±6.36 P值 0.38 0.45 0.67 0.97 0.89 
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表 2 2组手术结果比较
例(%)，X±S 组别 手术时间/min 手术出血量/mL 术后住院时间/d 手术并发症 输尿管恢复情况 完全恢复 部分恢复 A组(24例) 114.42±29.84 5.88±4.81 10.17±2.65 2(8.3) 22(91.7) 2(8.3) B组(27例) 129.59±47.42 5.81±4.25 10.56±3.23 2(7.4) 26(96.3) 1(3.7) P值 0.18 0.96 0.64 0.32 0.59
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