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首页> 美国卫生研究院文献>PLoS Clinical Trials >Technical Modifications of Double-J Stenting for Retroperitoneal Laparoscopic Dismembered Pyeloplasty in Children under 5 Years Old
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Technical Modifications of Double-J Stenting for Retroperitoneal Laparoscopic Dismembered Pyeloplasty in Children under 5 Years Old

机译：5岁以下儿童腹膜后腹腔镜肢体切除术双J支架的技术改造

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Both antegrade stenting and retrograde stenting for retroperitoneal laparoscopic dismembered pyeloplasty in children have many disadvantages. In this work, we tried using an alternative technique of modified antegrade (MAG) double-J stenting for retroperitoneal laparoscopic dismembered pyeloplasty in children under 5 years old, analyzed our results using the conventional antegrade (CAG) and the MAG techniques of stent insertion for this procedure, and reported our experience with these techniques. Between December 2002 and July 2010, 77 children under 5 years old with ureteropelvic junction obstruction underwent retroperitoneal laparoscopic dismembered pyeloplasty. CAG and MAG double-J stenting were attempted, in the first 36 cases (mean age 27.1 months) and the following 41 cases (mean age 25.4 months), respectively. The stents were removed 4–6 weeks later via cystoscopy. Follow-up studies were performed with ultrasonography and intravenous urography at 3 and 12 months postoperatively. The results showed that successful stent placement without malpositioning was achieved in 31 of 36 (86%) and all 41 (100%) cases, in the CAG and MAG groups, respectively. The common factor of unsuccessful stent was the inability to across the ureterovesical junction. The mean stent insertion time was 10 min 54 s and 12 min 46 s in the CAG and MAG groups, respectively. The mean operating time was 176 min and 185 min in the CAG and MAG groups, respectively. No stent malpositioning occurred in the MAG group; in the CAG group, two children had a malpositioned stent in the distal ureter and one child presented with a severe hematuria. Twelve months follow-up showed no new onset of hydroureteronephrosis and hydronephrosis. Thus we concluded that the MAG double-J stenting seems more reliable than CAG stenting for retroperitoneal laparoscopic dismembered pyeloplasty in children under 5 years old, with greater success and lower complication rates.
机译：儿童腹膜后腹腔镜肢解性肾盂成形术的顺行支架和逆行支架都有许多缺点。在这项工作中，我们尝试使用改良的顺行（MAG）双J支架替代技术对5岁以下儿童进行腹膜后腹腔镜肢体切除术，并使用常规顺行（CAG）和MAG支架置入技术来分析我们的结果此过程，并报告了我们在这些技术上的经验。在2002年12月至2010年7月之间，对77例5岁以下输尿管-盆腔交界处梗阻的儿童进行了腹膜后腹腔镜肢解性肾盂成形术。在前36例（平均年龄27.1个月）和随后的41例（平均年龄25.4个月）分别尝试了CAG和MAG双J支架置入术。 4-6周后通过膀胱镜检查取下支架。术后3个月和12个月用超声检查和静脉输尿管造影进行随访研究。结果显示，CAG组和MAG组分别有36例中的31例（86％）和所有41例（100％）成功完成了支架的放置而没有错位。支架未成功的常见因素是无法穿过输尿管膀胱交界处。 CAG组和MAG组的平均支架插入时间分别为10分钟54 s和12 min 46 s。 CAG和MAG组的平均手术时间分别为176分钟和185分钟。 MAG组未发生支架错位。在CAG组中，两个孩子的输尿管远端支架错位，一个孩子表现为严重的血尿。十二个月的随访未发现输尿管肾积水和肾积水的新发。因此，我们得出结论，对于5岁以下儿童，腹膜后腹腔镜肢解性肾成形术，MAG双J支架置入似乎比CAG支架更可靠，并获得更大的成功率和更低的并发症发生率。

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