腹腔镜肾盂成形术后非计划再手术的危险因素分析OA北大核心CSTPCD

Objective To explore the risk factors of unplanned reoperation(UR)after laparoscopic py-eloplasty(LP)in children with ureteropelvic junction obstruction(UPJO)and examine the clinical character-istics of UR children.Methods From March 2010 to December 2023,the relevant clinical data were retro-spectively reviewed for 678 children of unilateral UPJO undergoing LP.Children undergoing UR after LP were selected as study group and those without UR as control group.Gender,age,history of nephrostomy,Society of Fetal Urology(SFU)grade,surgical proficiency and postoperative hospitalization stay of two groups were col-lected for univariate and multivariate Logistic regression analyses.Statistical analysis was performed with SPSS version 26.0 software package.Results Among them,19(2.8％)cases underwent UR.According to the timing of reoperation,it was assigned into short-term and long-term URs.Four children(4/678,0.6％)underwent short-term UR for uroabdomen and allantois due to anastomotic leakage,varying degrees of intestinal obstruction and ab-dominal infection.Long-term UR was performed in 15 children(15/678,2.2％)for recurrent UPJO,aggravation of hydronephrosis,recurrent abdominal pain,urinary tract infection and hematuria.According to univariate analy-sis,anteroposterior diameter(APD),postoperative hospitalization stay,surgical proficiency,preoperative severity of hydronephrosis and presence of percutaneous nephrostomy were associated with UR(P＜0.05).Based upon multivariable analysis,APD(OR=1.278,95％CI:1.069-1.528),postoperative hospitalization stay(OR=1.165,95％CI:1.094-1.239),surgical proficiency(OR=1.165,95％CI:1.094-1.239)and presence of per-cutaneous nephrostomy(OR=17.817,95％CI:3.291-96.446)were the strongest predictors of UR(P＜0.05).Conclusions APD,postoperative hospitalization stay,surgical proficiency and presence of percutaneous nephrostomy are correlated with UR.Timely renal ultrasonography,evaluation of renal function,accurate intraoper-ative handling and a lowered risk of complications are vital for preventing and minimizing UR.