实用医学杂志 ›› 2023, Vol. 39 ›› Issue (12): 1541-1545.doi: 10.3969/j.issn.1006⁃5725.2023.12.014

• 临床研究 • 上一篇    下一篇

Lich⁃Gregoir 和Cohen 两种经腹腔镜术式治疗儿童输尿管膀胱连接部畸形的效果和安全性比较 

邱杰1 喻正波1 陈玉烛2 施晓欣2 罗震3 庄利恺4 顾胜利1    

  1. 1 遵义市第一人民医院(遵义医科大学第三附属医院)小儿外科(贵州遵义563000);遵义医科大学附属医 院2 泌尿外科,3 小儿泌尿外科(贵州遵义563000);4 复旦大学附属儿科医院泌尿外科(上海 201102)
  • 出版日期:2023-06-25 发布日期:2023-06-25
  • 通讯作者: 顾胜利 E⁃mail:536481876@qq.com
  • 基金资助:
    贵州省卫生健康委科学技术基金项目(编号:gzwkj2021⁃291)

Clinical efficacy and safety of laparoscopic Lich⁃Regoir and Cohen techniques in the treatment of uretero⁃ bladder junction malformation in children 

QIU Jie*,YU Zhengbo,CHEN Yuzhu,SHI Xiaoxin,LUO Zheng, ZHUANG Likai,GU Shengli.    

  1. Pediatric Surgery Department,Zunyi First People′s Hospital,Zunyi Medical Univer⁃ sity,Zunyi 563000,China 
  • Online:2023-06-25 Published:2023-06-25
  • Contact: GU Shengli E⁃mail:536481876@qq.com

摘要:

目的 比较经腹腔镜 Lich⁃Gregoir 术式和经气膀胱腹腔镜 Cohen 术式治疗儿童输尿管膀胱连 接部畸形的临床效果和安全性。方法 回顾性分析医院小儿外科 2018 年 2 月至 2022 年 9 月收治的 70 例 儿童输尿管膀胱连接部畸形患儿,根据术式差异,分为两组。A 组 35 例,采用经腹腔镜 Lich⁃Gregoir 术式 治疗;B 组 35 例,采用经气膀胱腹腔镜 Cohen 术式治疗。比较两组患儿手术指标、治疗效果、并发症、氧 化应激[超氧化物歧化酶(SOD)、丙二醛(MDA)、皮质醇(Cor)和肾上腺素(E)]和炎性因子[肿瘤坏死因子⁃α (TNF⁃α)、白细胞介素⁃8(IL⁃8)和 IL⁃10]水平差异。结果 B 组患儿住院时间显著少于 A 组(P < 0.05);两组术后 3 个月排尿性膀胱尿道造影(VCUG)复查结果提示所有患儿肾积水程度均减轻,无反流;两组术 后并发症发生率比较差异无统计学意义(2.86% vs. 5.72%,P > 0.05);两组患儿术毕时血清 SOD 活性显著 降低,MDA、Cor、E、TNF⁃α、IL⁃8和IL⁃10水平显著增加(P < 0.05),两组间比较差异无统计学意义(P > 0.05)。 结论 经腹腔镜 Lich⁃Gregoir 术式和经气膀胱腹腔镜 Cohen 术式治疗儿童输尿管膀胱连接部畸形的疗效和 安全性相当,对患儿应激和炎性程度影响接近,临床医生应根据实际情况择优选择。 

关键词: 输尿管膀胱连接部畸形, 儿童, Lich?Gregoir 术, Cohen 术

Abstract:

Objective To compare the clinical effect and safety of laparoscopic Lich⁃Gregoir and laparo⁃ scopic Cohen techniques in the treatment of children′s uretero⁃bladder junction malformation. Methods The clinical data of 70 children with ureterovesical conjunctival malformation admitted to the pediatric surgery department of our hospital from February 2018 to September 2022 were retrospectively reviewed and analyzed. The patients treated by laparoscopic Lich⁃Gregoir approach were assigned to group A(n = 35)and those treated by laparoscopic Cohen approach to group B(n = 35). The two groups were compared in terms of surgical indexes,therapeutic effects, complications,oxidative stress including levels of superoxide dismutase(SOD),malondialdehyde(MDA),cortisol (Cor)and epinephrine(E),and inflammatory factors including tumor necrosis factor⁃α(TNF⁃α),interleukin⁃8 (IL ⁃8)and IL ⁃10.  Results The average hospital stay in group B was significantly shorter than that in group A (P < 0.05). The reexamination results of urinary cystourethrography(VCUG)3 months after operation in both groups indicated that hydronephrosis was relieved and no reflux was observed in all the children. There was no significant difference in the incidence of postoperative complications between the two groups(2.86% vs. 5.72%, P > 0.05). After surgery,the serum SOD activity was significantly decreased,and the levels of MDA,Cor,E,TNF⁃α, IL⁃8 and IL⁃10 were significantly increased in both groups(P < 0.05),but there was no significant difference between the two groups(P > 0.05). Conclusion Laparoscopic Lich ⁃Regoir technique and laparoscopic Cohen technique have the same efficacy and safety in the treatment of children′s uretero⁃bladder junction malformation, and have a similar impact on the stress and inflammation in them. Surgeons should optimize their surgical approaches according to the conditions of diseased children and their own proficiency in the surgical operation. 

Key words: ureterovesical junction malformation, children, Lich?Gregor technique, cohen technique