背景:小儿肾积水提出了不同的挑战,特别是在涉及马蹄肾(HSK)的病例中。这项回顾性研究比较了小儿肾盂输尿管连接部梗阻(UPJO)患者HSK与非马蹄肾(NHSK)之间的治疗结果。
方法:一项回顾性队列研究包括35例HSK患者和790例NHSK患者进行肾盂成形术。术前,术中,和术后参数进行了评估。NHSK组的倾向评分匹配(PSM)平衡患者特征。
结果:与NHSK相比,HSK表现出更高的穿越血管发生率(51.6%vs.5.12%,P<0.001)和术前骨盆前后直径(APD)较小。6个月和12个月后,NHSK维持了更大的APD,12个月时市盈率较高。PSM在HSK中保留了显着更高的穿越血管发生率(51.6vs.3.61%,P<0.001)。HSK的腹腔镜肾盂成形术(LP)显示术后住院时间(LOS)较低。术后超声参数有利于NHSK。在HSK和NHSK有交叉船只,即使在PSM后,HSK也表现出更高的并发症(38.5%vs.0%,P=0.039)。
结论:该研究强调了识别HSK相关肾积水中交叉血管的重要性。手术成功,虽然HSK和NHSK具有可比性,需要量身定制的方法。这项调查为儿科泌尿外科提供了宝贵的见解,强调个性化管理以获得最佳结果。
BACKGROUND: Pediatric hydronephrosis poses distinct challenges, particularly in cases involving horseshoe kidneys (HSK). This retrospective study compares treatment outcomes between HSK and non-horseshoe kidneys (NHSK) in pediatric ureteropelvic junction obstruction (UPJO) patients.
METHODS: A retrospective cohort study included 35 patients with HSK and 790 patients with NHSK undergoing pyeloplasty. Preoperative, intraoperative, and postoperative parameters were evaluated. Propensity score matching (PSM) balanced patient characteristics in the NHSK group.
RESULTS: In comparison with NHSK, HSK exhibited a higher crossing vessel incidence (51.6% vs. 5.12%, P < 0.001) and smaller preoperative anteroposterior pelvic diameter (APD). Post 6 and 12 months, NHSK maintained a larger APD, with a higher P/C ratio at 12 months. PSM retained significantly higher crossing vessel incidence in HSK (51.6 vs. 3.61%, P < 0.001). Laparoscopic pyeloplasty (LP) in HSK showed lower postoperative length of stay (LOS). Postoperative ultrasound parameters favored NHSK. In HSK and NHSK with crossing vessels, HSK demonstrated higher complications even post-PSM (38.5% vs. 0%, P = 0.039).
CONCLUSIONS: The study emphasizes the importance of recognizing crossing vessels in HSK-related hydronephrosis. Surgical success, although comparable between HSK and NHSK, requires tailored approaches. This investigation contributes valuable insights to pediatric urology, emphasizing personalized management for optimal outcomes.