A Comparative Study Of Transabdominal Laparoscopic And Open Pyeloplasty In The Treatment Of Severe Hydronephrosis Caused By UPJO In Children

Objective:In this study,we compared transabdominal laparoscopic pyeloplasty with open pyeloplasty in the treatment of severe hydronephrosis caused by UPJO in children,and analyzed the efficacy,advantages,disadvantages and complications of the two surgical methods in different age groups.We also discussed the clinical feasibility of laparoscopic pyeloplasty in the treatment of severe hydronephrosis caused by UPJO in children.To provide more support for the treatment of severe hydronephrosis caused by UPJO in children.Methods:Retrospective analysis 142 cases of patients of the Department of Urology,Lanzhou University Second Hospital from June 2011 to May 2018,preoperative B-ultrasound,CTU and MRU or intraoperative or postoperative pathological diagnosis confirmed as ureteropelvic junction obstruction(UPJO)with severe hydronephrosis and underwent surgery.All the children developed normally.Case data were used to extract the sex,age,cause of diagnosis,location,preoperative B-ultrasound or CTU or MRU examination results,surgical procedure(laparoscopic VS open),operation time,length of surgical incision,intraoperative blood loss,renal pelvis Urine drainage,antibiotic use,postoperative analgesic use,postoperative perirenal drainage tube indwelling time,postoperative complications,postoperative hospital stay and hospitalization costs and other indicators and data.We used SPSS 22.0 statistical software to analyze the data,and P<0.05 considered the difference to be statistically significant.Results:There was no significant difference in age,sex,location of the affected side and the reason of visiting the doctor between the two groups in different age groups.There was no significant difference in operation time between LP group and OP group in 0~12 months(P=0.143),13~36 months(P=0.674)and 37~72 months(P=0.419).The average operation time of LP group was longer than that of OP group in 73~144 months(P=0.005).The average length of incision in LP group was significantly smaller than that in OP group,and the difference was statistically significant.The average intraoperative bleeding volume in LP group was less than that in OP group,and the difference was statistically significant.There was no significant difference in the renal pelvis drainage methods between the two groups in different age groups.There was no significant difference in the number of children with analgesics after operation between LP group and OP group in 0~12 months(P=0.389)and 13~36 months(P=0.256).However,in 37~72 months(P=0.048)and 73~144 months(P=0.045),the proportion of patients who used analgesics in LP group was lower than that in OP group,and the difference was statistically significant.There was no significant difference in complications between LP group and OP group in all age groups.The days of postoperative hospitalization and hospitalization expenses in all age groups were higher in the LP group than in the OP group,and the difference was statistically significant.Conclusion : The short-term success rate of transabdominal laparoscopic pyeloplasty for the treatment of severe hydronephrosis caused by UPJO in children of all ages is similar to that of open surgery.The operation was small,safe and reliable,with less bleeding,quick recovery,good incision cosmetic effect;postoperative complications were similar to the open group.It can be recommended for the treatment of severe hydronephrosis caused by UPJO in children.