| Background:The popularity of prenatal ultrasonography has led to an increasing number of cases of hydronephrosis in infants,with an incidence of about 1%?5%[1].The incidence in males is higher than that in females,and the incidence on the left side is higher than that on the right side,and about 10%of the children suffer from bilateral co-morbidity[2,3].The etiology of hydronephrosis in infants is quite complicated,and the common reasons include ureteropelvic junction obstruction(UPJO),ureterovesical junction,and bladder and vesicoureteral reflux,etc.UPJO is the most common cause of hydronephrosis,accounting for more than 85%.Although the timing of treatment for infantile hydronephrosis is still controversial,early diagnosis and early treatment should be adopted for severe hydronephrosis[4].When the hydronephrosis in infants develops severely,the renal cortex thins and the kidney appears as an airball,which may rupture when impacted by external forces and even endanger life[5].Regarding the surgical indications of hydronephrosis in infants,professor Yiee[6]from the university of California has proposed six criteria:(1)The anteroposterior diameter of the renal pelvis is more than 30mm;(2)the anteroposterior diameter of the renal pelvis is more than 20mm,combined with caliectasis;(3)renal function is less than 30%;(4)deteriorating renal function;(5)increased hydronephrosis;(6)symptomatic hydronephrosis.At present,surgical treatment is mainly adopted for severe hydronephrosis in infants.With the development of laparoscopic technology,laparoscopic pyeloplasty has become a trend in the treatment of severe hydronephrosis in infants[4].Through the comparison between laparoscopic pyeloplasty and open pyeloplasty,this paper analyzes the clinical efficacy and safety of laparoscopic pyeloplasty,which is summarized as follows.Purpose:Through comparing the differences in the therapeutic effects of open pyeloplasty and laparoscopic pyeloplasty in severe hydronephrosis in infants,this study attempts to provide a basis for the selection of surgical methods for severe hydronephrosis in infants in clinical practice.Methods:It adopts the retrospective analysis of 55 cases of children with severe hydronephrosis admitted to the pediatric surgery department of Henan People's Hospital from January 2015 to August 2017,a total of 34 children were treated with open pyeloplasty,being set as the open group,a total of 21 children were treated with laparoscopic pyeloplasty,being set as the laparoscopic group.It compares the duration of surgery,intraoperative blood loss,length of hospital stay,and the reduction of anteroposterior diameter of the renal pelvis and the increase of glomerular filtration rate between the two groups.Result:The duration of surgery(99.36±18.73)min in the laparoscopic group is higher than that in the open group(88.07±16.54)min,intraoperative blood loss(17.65±8.21)ml and length of hospital stay(8.46±2.51)d in the laparoscopic group are lower than(63.92±14.77)ml and 11.09±3.43)d in the open group,the differences have statistical significance(P<0.05).Through comparing the reduction in anteroposterior diameter of the renal pelvis(21.93±4.03)mm and the increase in glomerular filtration rate(18.03±4.69)ml/min in the laparoscopic group with(20.46±4.56)mm and(16.95±4.22)ml/min in the open group,the differences have no statistical significance(P>0.05).Conclusion:Laparoscopic pyeloplasty for the treatment of severe hydronephrosis in infants has the advantages of less intraoperative blood loss,shorter hospital stay,faster recovery and beautiful incision.However,since infants are little,the operating space of laparoscopy is small,compared with open pyeloplasty,the operation of laparoscopic anastomosis is relatively difficult and the operation time is relatively long.Therefore,the appropriate surgical method should be selected clinically according to the specific situation of the infants. |
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