Kết quả phẫu thuật tạo hình khúc nối bể thận

Kết quả phẫu thuật tạo hình khúc nối bể thận - niệu quản có sử dụng thông JJ

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Tác giả: Hoàng Mai Dương, Ngọc Thạch Phạm

Ngôn ngữ: vie

Ký hiệu phân loại:

Thông tin xuất bản: Tạp chí Y Dược học Phạm Ngọc Thạch, 2023

Mô tả vật lý: tr.46

Bộ sưu tập: Metadata

ID: 339248

Thêm vào giỏ Liên kết toàn văn

- Đặt vấn đề: Hiện có nhiều phương pháp chuyển lưu dòng nước tiểu sau phẫu thuật tạo hình khúc nối bể thận niệu quản. Nghiên cứu này nhằm đánh giá kết quả chuyển dòng nước tiểu bên trong với thông JJ trong phẫu thuật tạo hình khúc nối bể thận - niệu quản ở trẻ em và so sánh giữa nhóm phẫu thuật nội soi và mổ mở.- Đối tượng và phương pháp nghiên cứu: Mô tả loạt ca 98 bệnh nhi trong đó có 3 trường hợp phẫu thuật 2 bên (tổng cộng là 101 đơn vị thận) được chia làm hai nhóm phẫu thuật nội soi và phẫu thuật mổ mở, tất cả được tạo hình khúc nối bể thận - niệu quản có đặt thông JJ tại Bệnh viện Nhi Đồng 2 từ 01/01/2013 đến 31/10/2015. Thông tin trước mổ, trong mổ, biến chứng và kết quả sau mổ được ghi nhận. Thời gian theo dõi sau mổ từ 6 tháng đến 3 năm.- Kết quả: Có 54 trường hợp được phẫu thuật nội soi qua đường xuyên phúc mạc, trong đó 2 trường hợp nội soi chuyển mổ mở. 47 trường hợp được phẫu thuật mở. Trong nhóm phẫu thuật mở có 6 trường hợp nhiễm khuẩn niệu sau mổ (12,8%) đáp ứng điều trị nội. Nhóm phẫu thuật nội soi có 6 trường hợp mổ lại vì rò nước tiểu kéo dài, hẹp miệng nối và thông JJ lạc chỗ. Các biến chứng của nhóm phẫu thuật nội soi bao gồm: có 3 trường hợp nhiễm khuẩn niệu (5,8%), có 6 trường hợp JJ lạc chỗ (11,5%), có 4 trường hợp rò nước tiểu (7,7%), có 1 trường hợp hẹp miệng nối (1,9%) và 1 trường hợp sỏi bàng quang (1,9%). Tỷ lệ thành công chung của 2 nhóm là 94,1%. Tỷ lệ cải thiện mức độ ứ nước sau mổ là 90,1% với thời gian theo dõi trung bình 12,1 tháng. - Kết luận: Chuyển dòng nước tiểu với thông JJ trong phẫu thuật mở tạo hình khúc nối bể thận - niệu quản với tỷ lệ thành công khá cao 94,1%. Phương pháp này an toàn, hiệu quả. Với phẫu thuật nội soi tạo hình khúc nối bể thận - niệu quản qua đường xuyên phúc mạc, phẫu thuật viên cần có thêm nhiều kinh nghiệm để giảm tỷ lệ biến chứng.Abstract- Objectives: To evaluate the result of using internal urinary diversion (double J stent) in dismembered pyeloplasty in children.- Methods: A case series of 98 pediatric patients (101 renal units) undergoing a dismembered pyeloplasty procedure using double J stent was retrospectively reviewed at Children Hospital Number 2 from 01/01/2013 to 31/10/2015. The preoperative, intraoperative and postoperative data were recorded. Follow - up period ranged from 6 months to 3 years.- Results: There were 54 cases undergoing transperitoneal laparoscopic pyeloplasty, 2 cases converted to open pyeloplasty due to difficulty. 47 cases underwent open pyeloplasty. In the open group, there were 6 cases (12,8%) of urinary tract infection (UTI) which is treated well with antibiotic. In the laparoscopic group, 6 cases required a second operation due to prolonged leakage, recurrent obstruction and stent displacement. Complications of the laparoscopic group were recorded in 3 cases of UTI (5,8%), 6 cases of stent displacement (11,5%), 4 cases of leakage (7,7%), 1 case of obstruction (1,9%) and 1 case of vesical calculus (1,9%). The success rate was 94,1% in the whole study. The post - operative hydronephrosis improvement was recorded in 90,1% after the mean follow - up period of 12,1 months.- Conclusions: Using double J stent for urinary diversion in open dismembered pyeloplasty is a safe and efficient option. In transperitoneal laparoscopic pyeloplasty using double J stent, surgeons should have much experience to reduce the complication rate. DOI: 10.59715/pntjmp.2.2.6

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