| Objective : To evaluate the clinical effect of pneumocystoscopic and open-operation in the treatment of ureteral stricture in children.Methods: The clinical data and postoperative pathology of 120 cases(133 sides)of bladder and ureter junction obstruction in our hospital from April 2013 to March 2018 were reviewed,and the postoperative pathology was confirmed to be the end of the ureter.The operation was divided into two groups: A(pneumocystoscopic)and B(open),and 61 cases(68 sides)of group A were treated with a three-channel air-bladder laparoscopic Cohen replantation,and 59 patients(65)in group B underwent open Cohen replantation.Laparoscopic Cohen replantation of gas and bladder was performed by inserting cystoscopy through urethra to establish CO2 gas bladder.Under cystoscopy,the abdominal wall and bladder were suspended with needle suture.Trocar(5 mm)and2 operations trocar(3 mm),were inserted to complete ureter free and replicating under laparoscopy.All the children were followed up for routine follow-up,and the changes of hydronephrosis and the dilatation of the lower part of the ureter were assessed by B-mode ultrasound in 6 months after the operation,and the patency of the ureterovesical junction was assessed by the IVP examination at 12 months after the operation,and the degree of dilatation of the renal pelvis and the diameter of the lower part of the urinary tract were measured.The length of the incision,the time of operation,the time of retention,the time of hospitalization and the degree of appearance of the two groups were compared and analyzed.The appearance satisfaction was assessed in the form of a questionnaire with the Likert scale at 6 months post-operation.Results: The operation of 120 cases of replantation of the bladder was successful.There was no case of secondary operation.All cases were followed up.The maximum-urinary flow rate,the maximum bladder pressure capacity,the bladder compliance,and the maximum detrusor muscle pressure in group A were not statistically significant after the operation.The bladder compliance was 8.6±1.7ml/cmH2 O in group B and the difference was significant before operation.The difference of the remaining indexes was not statistically significant.In group A,the separation of the renal pelvis and the expansion of the end of the ureter were 0.6±0.1 cm and 0.4±0.2 cm,respectively.The B-group was 0.7±0.1 cm and 0.5±0.2 cm,respectively.At 12 months after operation,the IVU was reexamined.All the cases showed that the contrast agent was smooth at the junction of the ureter and the bladder,and 40 cases of Group A and 39 patients with B group were selected to be clear,and the degree of expansion of the renal pelvis and the end of the ureter was measured.In group A,the expansion of the renal pelvis and the end of the ureter were 0.7±0.2 cm and 0.5±0.1 cm,respectively,and the group B was 0.9±0.1 cm and 0.6±0.2 cm,respectively.The two groups were also significantly reduced before operation.There was no significant difference between the two groups(P > 0.05),and there was no significant difference between the two groups(P > 0.05).The length of the two groups was 0.8±0.3 cm,2.8±1.2 cm,(P <0.05),operation time was 133.3±16.7,96.1±17.1 min(P <0.05),the retention time was 6.3±1.3 d,10.4±1.2 d,(P <0.05),and the postoperative hospital stay was 7.6±1.2d,11.3±2.1d,(P <0.05).The satisfaction scores of the parents on the appearance of the operation were4.2±0.5、2.8±1.2(P<0.05).Conclusion: Laparoscopic Cohen reimplantation of air and bladder is feasible,safe and effective in the treatment of end ureter stricture in children.Compared with open surgery,it has the advantages of less trauma,faster recovery,more beautiful appearance and higher parents’ satisfaction,which is worthy of clinical promotion. |
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