Clinical Analysis Of Open And Pneumovesical Cohen Approach For Treatment Of Ureterovesical Junction Obstruction In Children

Purpose: To compare the efficacy of open and air bladder Cohen ureter replantation in the treatment of ureterovesical junction obstruction(UVJO)disease in children,and analyze the risk factors of postoperative urinary tract infection in children.Methods: Collect relevant clinical data of children undergoing ureteral replantation in the Department of Pediatric Surgery of the First Affiliated Hospital of Guangxi Medical University from January 2014 to December 2020,and screen children who underwent open Cohen ureteral replantation and air bladder Cohen ureteral replantation There were 55 cases(68 ureters in total),46 boys and 9 girls.There were 39 cases of open Cohen ureteral replantation,16 cases of air bladder Cohen ureteral replantation,42 cases of unilateral ureteral replantation,and 13 cases of bilateral ureteral replantation.Due to the small number of bilateral cases,and related indicators are not multiples with unilateral cases,this study only included 42 children who underwent unilateral Cohen ureteral replantation.Grouped according to the operation method,analyzed the operation time,intraoperative blood loss,pain score on the first postoperative day,postoperative indwelling urinary catheter days,postoperative indwelling double J tube,postoperative bladder spasm,postoperative hospitalization Time,postoperative antibiotic use time and related prognostic indicators,etc.Comprehensive evaluation of the pros and cons of the two surgical methods in the treatment of pediatric UVJO disease,and explore the related risk factors of urinary tract infection after Cohen ureter replantation.Results:Comparing the clinical data of 42 children with unilateral open and air bladder Cohen ureteral replantation in our hospital,the results are as follows.1.According to the surgical method: the operation time of children in the air bladder group was significantly longer than that of the open group [207.00(183.50-225.25)VS 112.50(96.75-136.00)],intraoperative blood loss,postoperative antibiotic time,postoperative hospital stay,The pain score on the first day after surgery and the presence or absence of bladder spasm after surgery were reduced compared with the open group,and the difference was statistically significant(p<0.05).According to the comparative analysis of the data within the group,the two surgical methods have obvious curative effects.The anterior and posterior diameter of the renal pelvis and the maximum diameter of ureteral dilatation after the operation were significantly reduced compared with those before the operation.2.According to the occurrence of urinary tract infection after operation,they were divided into two groups: postoperative no urinary sensation group(NUTI group: 18 cases)and postoperative urinary sensation group(UTI group: 24 cases).Through univariate comparative analysis to find out the indicators with statistical significance,the results suggest that age and the maximum diameter of preoperative ureteral dilatation are related factors that affect the occurrence of urinary tract infection after surgery(P<0.05).The binary logistic regression analysis was used to further explore the relationship between the two factors and postoperative urinary tract infection,and the ROC curve analysis was used to predict the best cut-off value of the two factors.The results suggest that the influencing factor "age" B=-0.035,P=0.020,OR=0.966,95%CI(0.938-0.995);the influencing factor "preoperative ureteral dilatation maximum diameter" B=3.106,P=0.013,OR= 22.328,95% CI(1.911-260.902).Conclusions: Analysis of the data in our hospital shows that Cohen ureteral replantation of the air bladder has a significant effect on the treatment of children with UVJO.Compared with the two,air bladder surgery has less trauma and faster recovery for children after surgery.It is a safe,effective,and minimally invasive excellent treatment method.However,it is still in the learning curve stage and the operation time is longer.However,no matter what kind of operation method,it is impossible to avoid the occurrence of urinary tract infection,a common complication.According to the preliminary prediction results of our hospital data:for children younger than 17.5 months who underwent Cohen ureteral replantation,urinary tract infection will occur after surgery.Children with the maximum diameter of preoperative ureteral dilatation> 1.55 cm are more likely to develop urinary tract infections after surgery.Every increase of 1.0 cm in the maximum diameter of preoperative ureteral dilatation increases the risk of postoperative urinary tract infection by approximately 22.3 times;for Children with two risk factors should be highly vigilant about the occurrence of urinary tract infection after surgery,and it is recommended to strengthen the follow-up after surgery.