肾盂输尿管连接处梗阻（ureteropelvic junction obstruction，UPJO）是小儿常见的先天性泌尿系统畸形，是引起儿童肾积水最常见疾病之一。该病是一类进展性疾病，若未得到及时的发现干预，可能会对肾脏产生不可逆性损害。肾盂输尿管离断成形术是目前治疗UPJO较优的手术选择，且已发展到在达芬奇机器人辅助下进行。目前对于影响UPJO患儿成形术术后肾功能恢复的影响因素存在较大争议，本文对此展开综述，旨在为临床决策及工作提供理论帮助。

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[1] ZHANG L, XU H, FENG Y, et al. Outcome of renalfunction after laparoscopic pyeloplasty in children with highgrade hydronephrosis [J]. Urol Int, 2023, 107(7): 666-671.

[2] TUBRE RW, GATTI JM. Surgical approaches to pediatricureteropelvic junction obstruction [J]. Curr Urol Rep, 2015,16(10): 72.

[3] 李怡,宋宏程,何雨竹,等.儿童先天性肾盂输尿管连接部梗阻性肾积水手术后分肾功能变化的短期随访研究[J].临床小儿外科杂志, 2021, 20(4): 312-318.

[4] KELLEY JC, WHITE JT, GOETZ JT, et al. Sonographicrenal parenchymal measurements for the evaluation andmanagement of ureteropelvic junction obstruction in children [J].Front Pediatr, 2016, 6(4): 42.

[5] YAYLA D, DEMIRTAS G, KARABULUT B, et al.What is the critical age for the improvement of parenchymalthickness after pyeloplasty? [J]. Urol J, 2023, 20(5): 344-349.

[6] MATERNY J, MAZURKIEWICZ I, GAWRYCH E, et al.Does hynes-anderson pyeloplasty improve renal function? [J].Ann Acad Med Stetin, 2010, 56(3): 95-102.

[7] HARRAZ AM, HELMY T, TAHA DE, et al. Changesin differential renal function after pyeloplasty in children [J].J Urol, 2013, 190(4 Suppl): 1468-1473.

[8] SARHAN O, AL OTAY A, AL FADDAGH A, et al.Pyeloplasty in children with low differential renal function:functional recoverability [J]. J Pediatr Urol, 2021, 17(5):658.e1-658.e9.

[9] NGUYEN HT, HERNDON CD, COOPER C, et al.The society for fetal urology consensus statement on theevaluation and management of antenatal hydronephrosis [J].J Pediatr Urol, 2010, 6(3): 212-231.

[10] HAN M, KIM HG, LEE JD, et al. Conversion andreliability of two urological grading systems in infants: thesociety for fetal urology and the urinary tract dilatationclassifications system [J]. Pediatr Radiol, 2017, 47(1): 65-73.

[11] HELMY TE, HARRAZ A, SHARAF DE, et al. Canrenal ultrasonography predict early success after pyeloplastyin children? A prospective study [J]. Urol Int, 2014, 93(4):406-410.

[12] CHIPDE SS, LAL H, GAMBHIR S, et al. Factorspredicting improvement of renal function after pyeloplastyin pediatric patients: a prospective study [J]. J Urol, 2012,188(1): 262-265.

[13] 刘帅,韩亚齐,摆俊博,等.以肾盂前后径为参考探讨UPJO所致肾积水手术时机的选择[J].临床泌尿外科杂志, 2022, 37(11):837-840.

[14] 李益卫,乔中伟,赵瑞芳,等,小儿肾积水肾盂成形术后分肾功能的改变及其影响因素分析[J].中华小儿外科杂志, 2016,37(1): 59-62.

[15] 曹琪,彭景涛,黄超,等.先天性肾盂输尿管连接处梗阻所致中度肾积水患儿手术时机的选择及疗效分析[J].临床泌尿外科杂志, 2023, 38(3): 174-178.

[16] ONEN A. Grading of hydronephrosis: an ongoing challenge [J].Front Pediatr, 2020, 27(8): 458.

[17] SZAVAY PO, LUITHLE T, SEITZ G, et al. Functionaloutcome after laparoscopic dismembered pyeloplasty in children [J].J Pediatr Urol, 2010, 6(4): 359-363.

[18] 林资咏,杨屹,殷晓鸣,等.小儿肾积水手术后分肾功能的相关因素分析及预测模型建立[J].临床小儿外科杂志, 2022, 21(2):156-161.

[19] 祖建成,何军,宁锋,等.离断式肾盂成形术对小儿肾积水的治疗及疗效影响因素分析[J].国际外科学杂志, 2019, 46(1):48-52.

[20] LAUNAY E, MORFOUACE M, DENEUX-THARAUX C,et al. Quality of reporting of studies evaluating time todiagnosis: a systematic review in paediatrics [J]. Arch DisChild, 2014, 99(3): 244-250.

[21] SCHERDEL P, DUNKEL L, VAN DOMMELEN P, et al.Growth monitoring as an early detection tool: a systematicreview [J]. Lancet Diabetes Endocrinol, 2016, 4(5): 447-456.

[22] BRASME JF, MORFOUACE M, GRILL J, et al. Delaysin diagnosis of paediatric cancers: a systematic review andcomparison with expert testimony in lawsuits [J]. LancetOncol, 2012, 13(10): e445-459.

[23] 杨平,李康明,邹兵,等.机器人辅助腹腔镜与传统腹腔镜肾盂成形术治疗小儿肾盂输尿管连接处梗阻的Meta分析[J].临床小儿外科杂志, 2022, 21(5): 482-489.

[24] 李凯,卢光军,李爱武,等.经腹腹腔镜Anderson-Hynes术不同操作通道在婴幼儿UPJO治疗中的对比研究[J].中华小儿外科杂志, 2021, 42(9): 788-793.

[25] ESPOSITO C, AUTORINO G, CASTAGNETTI M, et al.Robotics and future technical developments in pediatric urology [J].Semin Pediatr Surg, 2021, 30(4): 151082.

[26] GONZÁLEZ ST, ROSITO TE, TUR AB, et al. Multicentercomparative study of open, laparoscopic, and robotic pyeloplastyin the pediatric population for the treatment of ureteropelvicjunction obstruction (UPJO) [J]. Int Braz J Urol, 2022, 48(6):961-968.

[27] 周恩惠.腹腔镜离断式肾盂输尿管成形术治疗UPJO肾积水患儿围术期指标术后并发症及预后的影响[J].河北医学, 2020,26(10): 1663-1667.

[28] 陶承品,曹永胜,褚晗,等.比较离断性肾盂成形术不同手术方式治疗小儿肾盂输尿管连接部狭窄所致肾积水的效果分析[J].重庆医科大学学报, 2023, 48(4): 434-438.

[29] 孙永峰,明修熙,王东明.经腹入路腹腔镜下肾盂成形术治疗肾盂输尿管连接部梗阻的技巧探讨与经验总结(附53例报告)[J].腹腔镜外科杂志, 2020, 25(3): 234-236.

[30] CHAUHAN N, KENWAR DB, SINGH N, et al.Retroperitoneal single port versus transperitoneal multiportdonor nephrectomy: a prospective randomized control trial [J].J Endourol, 2018, 32(6): 496-501.

[31] 范正超,卢锦山,朱捷,等.经腹腔机器人辅助与后腹腔镜下离断式肾盂成形术的疗效比较[J].中华泌尿外科杂志, 2012,33(6): 417-420.

[32] 翟振兴,尚攀峰,张骕,等.腹腔镜经腹腔与后腹腔途径治疗肾盂输尿管连接部梗阻的比较[J].中国微创外科杂志, 2018,18(5): 405-408.

[33] BRAGA LH, PACE K, DEMARIA J, et al. Systematicreview and meta-analysis of robotic-assisted versus conventionallaparoscopic pyeloplasty for patients with ureteropelvic junctionobstruction: effect on operative time, length of hospital stay,postoperative complications, and success rate [J]. Eur Urol,2009, 56(5): 848-857.

[34] WORMSER C, CLARKE DL, ARONSON LR. Outcomesof ureteral surgery and ureteral stenting in cats: 117 cases (2006-2014) [J]. J Am Vet Med Assoc, 2016, 248(5): 518-525.

[35] 赵军锋,刘平,王爱和,等.输尿管支架管和肾盂造瘘管在小儿Anderson-Hynes术中的应用[C]//中华医学会,中华医学会小儿外科学分会.中华医学会第八次全国小儿外科学术会论文集, 2010: 237.

[36] 刘慧倩,王宁,姚俊杰,等.留置2根和3根双J管治疗良性继发性输尿管狭窄的疗效比较[J].现代泌尿外科杂志, 2023,28(5): 408-412.

[37] BARROS AA, OLIVEIRA C, LIMA E, et al. Gelatin-basedbiodegradable ureteral stents with enhanced mechanicalproperties [J]. Applied Materials Today, 2016, 5: 9-18.

[38] 李小瑜,郭云飞,黄立渠.分肾功能低于10%肾积水的治疗决策及影响因素研究进展[J].临床小儿外科杂志, 2021, 20(12):1183-1188.

[39] DEMIRTAŞA, GÜLESER AS, SÖNMEZ G, et al.Two-step treatment model for the adult patients with anobstructed kidney functioning below 10% of its capacity: apilot study [J]. Clin Exp Nephrol, 2020, 24(2): 185-189.

[40] DEVARAKONDA CKV, SHEARIER ER, HU C, et al.A novel urinary biomarker protein panel to identify childrenwith ureteropelvic junction obstruction-a pilot study [J]. JPediatr Uro, 2020, 16(4): 466.e1-466.e9.

[41] GROEN IN 'T WOUD S, REUVER N, FEITZ WFJ,et al. Compensatory hypertrophy in paediatric patients witha unilateral ureteropelvic junction obstruction [J]. Eur UrolOpen Sci, 2021, 27(34): 10-16.

牛愿坚,余晨惠,雷弘嵩,等.肾盂输尿管连接处梗阻患儿离断式肾盂成形术后肾功能恢复的影响因素[J].泌尿外科杂志(电子版),2024,16(03):58-63.DOI：10.20020/j.CNKI.1674-7410.2024.03.13

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先天性肾积水是儿童常见的泌尿系统异常，其发生率约为1%^[1]。近年来，胎儿及新生儿先天性肾积水的病例数日益增多，这与围产期B超检查的广泛应用及检查水平的提高密切相关。在引起儿童先天性肾积水的众多原因中，肾盂输尿管连接处梗阻（ureterpelvic junctionobstruction，UPJO）最为常见，约占10% ~30%^[2]。UPJO广义上是指由于各种原因导致尿液不能及时从肾盂引流向输尿管，继而引起肾积水、肾实质变薄、肾功能减弱，严重者可导致患肾萎缩的一类疾病。因此，及时手术干预对于此类患儿肾功能的保护至关重要，离断式肾盂成形术（Anderson-Hynes术）是目前治疗UPJO较优的手术方式，术后可恢复 部分形态学，但术后分肾功能（different renalfunction，DRF）是否可以恢复及恢复程度目前仍无统一的标准^[3]。UPJO的诊疗在国际上仍存在较大争议，争议点主要包括手术干预的最佳时机及哪类患儿能从手术中获益等方面。本文将根据现有的研究来探讨UPJO患儿行Anderson-Hynes术后患侧DRF恢复的相关影响因素，包括术前、术中及术后三类因素，为制定临床决策及术后个性化随访方案提供理论指导。

1 术前因素

1.1 手术年龄

1.2 术前积水程度

1.3 术前分肾功能

1.4 肾实质厚度

1.5 性别及患病侧

1.6 诊断时间

2 术中因素

2.1 手术方式及入路

3 术后因素

3.1 输尿管支架管（双 J管）

3.2 留置引流管时间

3.3 其他术后因素

综上所述，影响UPJO术后肾功能恢复的影响因素较多，其中术前分肾功能及术前肾实质厚度被一致认为是术后肾功能恢复的独立影响因素；大多数学者认为手术年龄和术前肾积水程度是术后肾功能的影响因素，但也有部分学者观点相反；诊断时间是否是肾功能恢复的影响因素尚无定论，而性别、患病侧、手术方式、手术入路、双J管留置时间及随访时间等均不被认为是影响术后肾功能的独立影响因素。出现争议的原因可能与纳入研究的病例数及缺乏对许多其他混杂变量的控制等因素有关，针对这一问题仍需进行更大样本、多中心及更精确的控制变量研究。总之，经过探讨，笔者认为对于UPJO患儿，可结合术前分肾功能、肾实质厚度、术前肾积水程度及年龄选择最佳手术干预时机，为患儿争取最大程度的预后。

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