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目的探讨支架管经尿道外引流在婴儿期肾盂输尿管成形术中的临床应用价值。方法行腹腔镜辅助肾盂成形术重度婴儿期肾积水患儿134例,随机分为外引流组89例和内引流组45例,外引流组在导丝引导下将支架管远端经尿道拉出体外并固定,近端放置于肾盂,不再留置导尿管;内引流组将支架管远端置入膀胱,近端放置于肾盂,留置F6号双腔尿管1周后拔除尿管。2组术后留置肾周引流管,2~3d后拔除,于术后2个月拔除支架管。结果 2组手术均顺利;内引流组支架管移位2例,其中支架管上移1例,下移至膀胱并脱出体外1例;外引流组支架管不慎拔出1例,无支架管移位,发生包皮感染2例;外引流组肾周引流管引流量[(70.5±3.6)mL]小于内引流组[(82.5±4.6)mL],肾盂分离减少值[(15.7±3.6)mm]、肾小球滤过率增加值[(10.6±2.7)mL/min]均高于内引流组[(14.3±3.2)mm、(9.6±2.3)mL/min](P<0.05);外引流组和内引流组手术时间[(76±10)、(78±13)min]、术后1周尿路感染发生率(29.21%、28.89%)、术后3个月尿路感染发生率(4.49%、6.67%)及术后并发症发生率(3.37%、4.44%)比较差异均无统计学意义(P>0.05)。结论腹腔镜辅助肾盂成形术中采用支架管经尿道外引流疗效确切,且不延长手术时间,不增加术后尿路感染及并发症发生率。
Objective To investigate the clinical value of stent-graft transurethral drainage in infantile ureteropelvic angioplasty. Methods 134 patients with severe infantile hydronephrosis were randomly divided into external drainage group (n = 89) and internal drainage group (n = 45). Laparoscopic assisted pyeloplasty in infants with severe infantile hydronephrosis Externally and fixed, the proximal end placed in the renal pelvis, catheter indwelling is no longer; within the drainage group will be placed into the distal tube stent bladder, proximal placed in the renal pelvis, indwelling F6 double lumen catheter removed after 1 week. Two groups of postoperative left renal drainage tube, 2 ~ 3d after removal, 2 months after removal of stent tube. Results The operation of the two groups was successful. In the group of internal drainage, the stent was displaced in 2 cases, in which the stent was moved upward in 1 case, down to the bladder and in vitro in 1 case. The stent was inadvertently removed in 1 case without stent (70.5 ± 3.6) mL in the external drainage group was smaller than that in the internal drainage group (82.5 ± 4.6) mL, and the reduction of the pelvic separation was (15.7 ± 3.6) mm in the external drainage group ], And glomerular filtration rate ([(10.6 ± 2.7) mL / min] were significantly higher than those in the internal drainage group (14.3 ± 3.2 mm, 9.6 ± 2.3 mL / min, P < The operative time of the drainage group and the internal drainage group was (76 ± 10), (78 ± 13) min, the incidence of urinary tract infection was 29.21% (28.89%) at 1 week after operation, and the incidence of urinary tract infection (4.49%, 6.67%) and the incidence of postoperative complications (3.37%, 4.44%) were not statistically significant (P> 0.05). Conclusion Laparoscopic assisted pyeloplasty using stent-graft transurethral drainage is effective, and does not extend the operation time, does not increase the postoperative urinary tract infection and the incidence of complications.