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目的·探讨分期肾盂成形术(先期肾造瘘)与不分期肾盂成形术治疗小于3个月重度肾积水患儿的临床效果。方法·回顾性分析上海交通大学医学院附属新华医院2012年1月—2015年7月接受手术治疗的小于3个月重度肾积水患儿的临床资料。25例行分期肾盂成形术(A组),39例行不分期肾盂成形术(B组)。比较2组手术时间、术中出血量、并发症发生率、总住院时间及术后肾积水恢复情况等。结果·共有64例小于3个月重度肾积水患儿纳入研究。A组手术时间、总住院时间、术后尿路感染发生率明显高于B组,分别为(81±20)min与(53±18)min、(11.6±2.6)d与(6.2±1.5)d、36.0%与17.9%。术后6个月,2组患儿肾积水程度和肾脏功能均得到显著改善,组间差异无统计学意义。结论·分期肾盂成形术对于小于3月龄重度积水患儿肾脏的最终形态、功能恢复没有明显优势;不分期肾盂成形术安全、有效,应作为小婴儿重度肾积水的首选治疗方式。
Objective · To investigate the clinical effect of staging pyeloplasty (advanced nephrostomy) and pyeloplasty in patients with severe hydronephrosis less than 3 months. Methods · The clinical data of children with severe hydronephrosis less than 3 months who underwent surgery from January 2012 to July 2015 in Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine were retrospectively analyzed. Twenty-five patients underwent stage pyeloplasty (group A) and 39 patients underwent pyeloplasty (group B). The operation time, intraoperative blood loss, complication rate, total length of hospital stay and recovery of postoperative hydronephrosis were compared between the two groups. Results · A total of 64 children younger than 3 months with severe hydronephrosis were included in the study. The incidence of postoperative urinary tract infection in group A was significantly higher than that in group B (81 ± 20) min and (53 ± 18) min, (11.6 ± 2.6) d and (6.2 ± 1.5) d, 36.0% and 17.9%. At 6 months after operation, the degree of hydronephrosis and renal function were significantly improved in both groups, with no significant difference between the two groups. Conclusion · Phased pyeloplasty for the final form of kidney in children less than 3 months of age with severe hydrocephalus, functional recovery has no obvious advantage; staging pyeloplasty safe and effective, should be used as the preferred treatment of severe hydronephrosis in infants.