Clinical Study On The Treatment Of Children Vesicoureteral Reflux By Pneumovesic Laparoscopic Cohen’s Ureteral Reimplantation

Objective To evaluate the feasibility and safety of pneumovesic laparoscopic ureteral reimplantation in the treatment of children with vesicoureteral reflux.Methods 70 children with vesicoureteral reflux who underwent ureteral replantation in our hospital from 201 7 to 2021 were divided into pneumovesic group and open group.35 children in pneumovesic group underwent laparoscopic Cohen’s ureteral replantation,35 children in open group underwent open Cohen’s ureteral replantation.Incision size,blood loss and operation time were recorded immediately during the operation.The occurrence of bladder spasm,hematuria time,catheter indentation time and pain degree were observed during hospitalization.The double J ureteral catheter was removed 1 month after surgery,and VCUG was re-examined in6 months to evaluate the regurgitant condition.B-ultrasound was re-examined in 3 months,6 months and 1 year.Regular follow-up visits were conducted to inquire about the growth of surgical incisions and the occurrence of bladder dysfunction such as frequent and urgent urination.Results There was no significant difference between the two groups in gender,age,reflux side and other basic information.Pneumovesic group of children with bladder incision size(1.5 cm),intraoperative blood loss(2.0 ml)were smaller than the open group(4.0 cm),(10.0 ml),operation time(185.3±54.2min)is greater than the open group(150.5 ±45.5 min);Postoperative hematuria time(4.7 ±2.1 d),indwelling time of urinary catheter(7.2±2.8 d),pain score(d1:2.5 ±0.7,d3:1.5±0.6),the incidence of frequent urination urgency(6%)in the pneumovesic group were less than those in the open group(6.0±1.3 d),(10.3±3.6 d),(d1:5.3±0.9,d3:2.9± 0.6)and(23%);The diameters of ureter were(1.4 ±0.4cm),(0.5±0.2cm)before and after operation in the pneumovesic group,and(1.3 ±0.5cm),(0.6±0.1cm)in the open group,and there was no significant difference between the two groups(P >0.05).The expansion of renal pelvis before and after operation were(2.1±0.3cm),(0.8±0.2cm)in the pneumovesic group,and(2.0 ±0.4cm),(0.7±0.3cm)in the open group,with no statistical significance between the two groups(P > 0.05);The incidence of postoperative bladder spasm(20%)in the pneumobladder group is less than that in the open group(94%),postoperative incision satisfaction(4.2±0.5)is greater than the open group(2.8±1.2),the difference was statistically significant(P < 0.05);The recurrence rate of postoperative urinary tract infection in the pneumobladder group(17%)was close to that in the open group(20%),and the difference was not statistically significant(P > 0.05).There was no recurrence of postoperative reflux in both groups.Conclusion Pneumovesic laparoscopic ureteral reimplantation has a significant effect in the treatment of primary vesicoureteral reflux,and has the advantages of less trauma,beautiful appearance,rapid recovery and little influence on bladder function.It is a relatively reliable choice for the treatment of children with vesicoureteral reflux.However,it is difficult to operate pneumovesic laparoscopic operation and requires more surgical experience.