| Objectives:To explore the application options of different surgical approaches in pediatric laparoscopic pyeloplasty.Methods:Retrospectively analyzed the clinical data of pediatric patients aged 14 years and younger who were admitted to the Second Affiliated Hospital of Kunming Medical University from May 2014 to January 2020,and who underwent pediatric laparoscopic pyeloplasty through different surgical approaches.According to the choice of surgical approach,the children were divided into two groups:transperitoneal surgical approach group and retroperitoneal surgical approach group.Then,the transperitoneal surgical approach group was divided into two subgroups:the transparacolonic window path group and the mesenteric window path group.Finally,the differences between the general data indicators,perioperative indicators and postoperative follow-up indicators of pediatric patients in two large groups and two subgroups were compared.Results:A total of 123 UPJO pediatric patients were included in this study.All operations were successfully completed,including 1 case converted to open surgery.The operation time was 115 to 197 minutes,with an average of 157.40 minutes,and the average intraoperative blood loss was 15.74 ml.The children got out of bed on average 24.08h after operation,and the abdominal drainage tube was pulled out on average 4.86d after operation.In 9 infants and young children,the omentum was taken out when the abdominal drainage tube was pulled out,and it was returned under anesthesia.The average postoperative discharge time was 4.99 days.After returning to hospital for an average of 11 weeks after surgery,the internal stent was successfully pulled out under ureteroscopy.Follow-up of the children ranged from 3 to 60 months.Reexamination of B-ultrasound and IVU showed that 82 cases of hydronephrosis disappeared,32 cases of hydronephrosis were alleviated,9 cases of hydronephrosis remained unchanged,and 9 cases of renal insufficiency were recovered to varying degrees.There were no statistically significant differences in gender,BMI,lesion side,hydronephrosis degree,operation time,intraoperative blood loss,activity time after getting out of bed,time of D-J tube removal,remission of hydronephrosis between the transperitoneal surgical approach group and the retroperitoneal surgical approach group(P>0.05);there were statistically significant differences in age,postoperative gastrointestinal function recovery time,drainage tube retention time,postoperative hospital stay,postoperative complications(P<0.05).There were no statistically significant differences in gender,age,BMI,hydronephrosis degree,operation time,intraoperative blood loss,postoperative gastrointestinal function recovery time,drainage tube retention time,activity time after getting out of bed,postoperative hospital stay,postoperative complications,time of D-J tube removal,remission of hydronephrosis between the transparacolonic window path group and the mesenteric window path group(P>0.05);there was statistically significant difference in lesion side(P<0.05).Conclusions:Pediatric laparoscopic pyeloplasty has a high success rate through different surgical approaches.The retroperitoneal approach can be used for older or well-developed children.It is recommended to use the transperitoneal surgery approach in the lower UPJO,younger,especially infants and young children.The mesenteric window path is the first choice for those with dilated left renal pelvis in the left descending colon frame and abnormal renal anatomy.The transparacolonic window path is the first choice for those with UPJO on the right,dilated left renal pelvis beyond the frame of the left descending colon,and abnormal left mesenteric vessels.Various approaches and paths have their own advantages.It is important to choose the surgical approach according to the development of children,age and anatomical structure,which can reduce the difficulty of surgical operations and postoperative complications,and improve the precision and success rate of surgery. |
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