儿童肾盂输尿管连接处梗阻伴感染的手术时机选择

韦超; 张德迎; 杨银; 王萱; 钟庆涛; 刘星; 华燚; 林涛; 何大维; 李旭良; 钟朝晖; 魏光辉

doi:10.16016/j.2097-0927.202112117

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儿童肾盂输尿管连接处梗阻伴感染的手术时机选择

临床医学 | 更新时间：2026-01-09

- 儿童肾盂输尿管连接处梗阻伴感染的手术时机选择
- Surgical timing for ureteropelvic junction obstruction complicated with upper urinary tract infection in children
- 陆军军医大学学报 2022年44卷第12期页码：1261-1265
- 作者机构：
  
  1.400014 重庆，重庆医科大学附属儿童医院泌尿外科，国家儿童健康与疾病临床医学研究中心，儿童发育疾病研究教育部重点实验室，儿科学重庆市重点实验室，儿童泌尿生殖发育与组织工程重点实验室
  2.400016重庆，重庆医科大学公共卫生学院
- 作者简介：
  
  [张德迎，E-mail：zdy@hospital.cqmu.edu.cnZHANG Deying, E-mail: zdy@hospital.cqmu.edu.cn
- 基金信息：
  
  重庆市科卫联合项目(2019GDRC007);重庆市渝中区基础研究与前沿探索项目(20200126);重庆医科大学未来医学青年创新团队项目(W0056)
- DOI：10.16016/j.2097-0927.202112117
  中图分类号： R726.1;R726.912;R726.913
- 收稿：2021-12-14，
  
  修回：2022-01-06，
  
  纸质出版：2022-06-30
- 稿件说明：
移动端阅览
韦超, 张德迎, 杨银, 等. 儿童肾盂输尿管连接处梗阻伴感染的手术时机选择[J]. 陆军军医大学学报, 2022,44(12):1261-1265.

Chao WEI, Deying ZHANG, Yin YANG, et al. Surgical timing for ureteropelvic junction obstruction complicated with upper urinary tract infection in children[J]. Journal of Army Medical University, 2022, 44(12): 1261-1265.
韦超, 张德迎, 杨银, 等. 儿童肾盂输尿管连接处梗阻伴感染的手术时机选择[J]. 陆军军医大学学报, 2022,44(12):1261-1265. DOI： 10.16016/j.2097-0927.202112117.

Chao WEI, Deying ZHANG, Yin YANG, et al. Surgical timing for ureteropelvic junction obstruction complicated with upper urinary tract infection in children[J]. Journal of Army Medical University, 2022, 44(12): 1261-1265. DOI： 10.16016/j.2097-0927.202112117.

摘要

目的

探讨不同手术时机对儿童肾盂输尿管连接处梗阻伴感染的围手术期基本情况及并发症、手术效果的影响。

方法

采用回顾性队列研究设计，收集2010年1月至2020年12月重庆医科大学附属儿童医院泌尿外科收治的46例肾盂输尿管连接处梗阻伴感染患儿的病例资料，按照感染控制后距手术时间分为早期手术组(≤1周，

=30)和延迟手术组(≥2个月，

=16)，比较两组围手术期基本情况(手术时间、术中出血量、术后住院时间)及并发症(发热、腰痛、腹胀、血尿、高血压、尿外渗、尿路感染)、手术效果(术后6个月肾积水程度、肾皮质改变、再手术)等差异。

结果

早期手术组和延迟手术组围手术期基本情况及并发症、再手术情况差异均无统计学意义。两组术后肾积水程度均较术前显著改善(

0.001)；延迟手术组改善水平略优于早期手术组，但差异无统计学意义(

=0.183)。早期手术组术后肾实质厚度改善28例(93.3%)，延迟手术组10例(62.5%)，两组差异有统计学意义(

=0.026)。

结论

儿童肾盂输尿管连接处梗阻伴感染早期或延迟行肾盂输尿管成形术对围手术期基本情况、并发症及再手术无显著影响；延迟手术肾积水程度改善略优于早期手术，但肾实质厚度改善却明显不及早期手术，提示早期手术解除梗阻有利于肾实质恢复，可避免进一步肾损伤。

Abstract

Objective

To investigate the effects of different surgical timing on perioperative basic conditions and complications and surgical outcomes in children suffering from ureteropelvic junction obstruction (UPJO) complicated with upper urinary tract infection.

Methods

A retrospective cohort study was adopted. Then clinical data of 46 UPJO children with upper urinary tract infection treated in our hospital from January 2010 to December 2020. According to the time from infection controlled to operation

they were divided into early operation group (≤1 week

=30) and delayed operation group (≥2 months

=16). The perioperative basic conditions (operation time

intraoperative bleeding volume

and postoperative stay) and complications (fever

lumbago

bloating

hematuria

hypertension

urinary extravasation

and urinary tract infection) and surgical outcomes (hydronephrosis

renal cortical changes

and reoperation within 6 months postoperatively) were compared between the 2 groups.

Results

There were no significant differences in perioperative basic conditions and complications and reoperation between the early and delayed operation groups. Postoperative hydronephrosis was greatly improved in both groups compared with the condition before operation (

0.001)

and better improvement was obtained in the delayed operation group than the early operation group

though no statistical difference (

=0.183). The thickness of renal parenchyma was improved in 28 cases (93.3%) in the early op

eration group and 10 cases (62.5%) in the delayed operation group

with obvious difference between them (

=0.026).

Conclusion

Early or delayed pyeloureteroplasty for UPJO complicated with infection in children have no significant effects on perioperative basic conditions

complications and reoperation. Delayed operation obtains slightly better improvement of hydronephrosis

but worse improvement in renal parenchyma thickness when compared with early operation. It is suggested that early removal for obstruction is helpful to the recovery of renal parenchyma so as to avoid further renal injury.

关键词

Keywords

references

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