To Compare The Clinical Efficacy Of Dismembered Pyeloplasty Via Different Surgical Approaches In The Treatment Of Ureteropelvic Junction Obstruction (UPJO) Induced Hydronephrosis In Children

Objective:The purpose of this study is to compare and evaluate conventional open open pyeloplasty(open Dismembered Pyeloplasty,OP)and conventional three-hole laparoscopic ureteroplasty(Conventional laparoscopic pyeloplasty,CLP)Two surgical methods for the pediatric ureteral junction obstruction(ureteropelvic junction obstruction,Analysis of safety of hydronephrosis in children and efficacy of UPJO).Method:A systematic review analyzed 90 clinical data of children with hydronephrosis caused by ureteral junction obstruction(UPJO)admitted in Anhui Hospital(Anhui Provincial Children’s Hospital)from January 2019 to October 2021,Perfect preoperative blood routine,urine routine,biochemical,coagulation and other five laboratory tests,Color urinary ultrasound,intravenous urography(IVU),diuretic renal nuclide imaging,MRI water imaging(MRU)or CT urinary tract imaging(CTU),Confirmed as hydronephrosis caused by obstruction of the ureteric junction,All of the children had moderate to severe hydronephrosis,Combined with symptoms such as lower back pain or urinary tract infection,Diuretic renal nuclide imaging suggests that the dividing renal function is less than 40%,After the exclusion of contraindications to surgery,Elective disconnection pyeloplasty treatment was performed.According to the surgical method,the children were divided into laparoscopic group(n=49)and conventional group(n=41).The laparoscopic children were treated by conventional umbilical three-hole laparoscopic fracture pyeloplasty,and the conventional group was treated with open lumbar abdominal transverse fracture pyeloplasty.In 90 cases,the ureteral stent tube(D-J tube)was successfully inserted by antegrade procedure,and the operation was successfully completed.Comparing the operation time,the incision length and postoperative acetaminophen dosage,the renal pelvis diameter and renal cortex thickness,the average postoperative hospital stay time,postoperative feeding time and postoperative hospitalization costs,and the incidence of postoperative incision infection,urinary extravasation and fever in the two groups.Statistical analysis was performed using SPSS20.0.Age measurement data are expressed in the form of(months),with independent sample t-test between groups and paired sample t-test within groups;count data are expressed as "%" and χ 2 test between groups,and P<0.05 was statistically significant.Results: Compared with the children in the conventional group,Children in the laparoscopic group had a slightly longer operation time,But the surgical incision length was much shorter,The operative bleeding and postoperative acetaminophen consumption were lower(P <0.05);postop,Compared to the conventional group,Children in the laparoscopic group had a lower anterior and posterior diameter in the renal pelvis,Higher renal cortex thickness(P <0.05);Compared with the children in the conventional group,Children in the laparoscopic group had a shorter mean postoperative hospital stay,A shorter mean food intake time after surgery,Postoperative hospitalization costs were lower(P <0.05);The incidence of postoperative complications in the laparoscopic group was 12.24%(6 / 49)lower than 36.58%(15 /41)in the conventional group(P <0.05).Conclusion: 90 cases of 90 children with hydronephrosis surgery are successful,two groups of surgery in treatment safety are good,laparoscopic severed renal pelvis ureteplasty group advantage is less bleeding in the operation,surgical incision is small,more minimally invasive beautiful effect,children in postoperative eating time and hospital stay shorter than conventional group,and the postoperative recovery time faster and less postoperative complications.To sum up the pediatric renal pelvis ureteral junction obstruction caused by hydronephrosis of renal pelvis ureteral plasty using conventional three hole laparoscopic surgery effect is significantly higher than the traditional lumbar abdominal transverse incision,the trauma,less bleeding,and the postoperative recovery,incision infection rate is low,can achieve more minimally invasive and beautiful treatment effect,the operation is worth better promotion and application.