腹腔镜及开放手术治疗儿童先天性肾盂输尿管连接处梗阻性肾积水的并发症对比OA北大核心CSTPCD

Objective To compare the perioperative complications and explore the potential factors con-tributing to the differences in complications between laparoscopic and open dismembered pyeloplasty for congen-ital ureteropelvic junction obstructive hydronephrosis in children.Methods Between July 2016 and December 2018,retrospective review was conducted for all children with ureteropelvic junction obstruction(UPJO)under-going primary transperitoneal laparoscopic pyeloplasty(LP)and retroperitoneal open pyeloplasty(OP)Periop-erative complications were compared between LP and OP.Complication rate,Clavien-Dindo grade and types were compared.Complications were also compared between different postoperative drainage modes and groups with or without intraoperative complications.Also the differences in postoperative complications were explored a-mong groups with varying age,weight,anterioposterior pelvic diameter(APD)and surgeon expertise.Results For 583 UPJO kidneys,LP was performed for 355 kidneys and OP for 228 kidneys.The median age of the open group was 16.37 months(9.73 months,61.37 months)and the median weight was 11.00 kg(9.30 kg,20.00 kg),which were significantly lower than the median age of the laparoscopic group,which was 46.87 months(19.08 months,90.49 months),and the median weight of 16.50 kg(12.00 kg,25.00 kg).The medi-an preoperative renal pelvis anteroposterior diameter in the open group was 39.00 mm(27.00 mm,52.00 mm),significantly larger than that of the laparoscopic group,which was 28.00 mm(22.00 mm,36.00 mm).These differences were statistically significant(P＜0.05).The inter-group incidence of intraoperative compli-cations showed no significant difference(LP:7.61％vs OP:4.39％).Also no significant inter-group difference existed in restenosis of anastomotic rate(LP:2.62％vs.OP:1.33％).Although no significant inter-group difference in the incidence or frequency of postoperative complications,types of complications differed.Urinary tract infections(UTIs)dominated in both groups.Kidneys with intraoperative complications were more prone to higher grades of postoperative complications(x2=5.600,P=0.018)and UTIs(x2=8.891,P=0.003).As compared with OP group,LP group showed a higher propensity for high-grade postoperative complications(Cla-vien Ⅲb)(x2=6.595,P=0.010)and other complications(x2=10.289,P=0.001),except for UTIs.Conclusions LP and OP are both safe and effective in UPJO children.However,types of complications differ.As compared with OP,LP requires a higher alert for the occurrence of complications and high-grade postopera-tive complications,except for UTIs.