| Sažetak | Cilj istraživanja: Cilj ovog istraživanja je odrediti demografske i kliničke karakteristike u djece operirane zbog hidronefroze u Zavodu za dječju kirurgiju Kliničkog bolničkog centra Split u razdoblju od prosinca 1990. do prosinca 2014. godine.
Ispitanici i metode: Retrospektivno su pregledane povijesti bolesti 228 djece, u kojih je proveden bilo kakav oblik liječenja hidronefroze (implantacija „double J“ proteze, pijeloplastika po metodi Hynes – Anderson ili nefrektomija) u razdoblju od prosinca 1990. do prosinca 2014. u Zavodu za dječju kirurgiju KBC Split. Kriteriji isključenja bili su bolesnici liječeni konzervativnim načinom, bolesnici sa ureterohidronefrozom kao i oni čiji su podaci nepotpuni. Srednja dob djece bila je 4 godine (raspon 0 - 18 godina). Srednja duljina boravka u bolnici bila je 8 dana (raspon 3 - 22 dana). Analizirani su dob, spol, lateralizacija, uspjeh zbrinjavanja hidronefroze te komplikacije.
Rezultati: U izabranom studijskom razdoblju istraživanje je obuhvatilo 228 bolesnika u kojih je provedeno kirurško liječenje hidronefroze u Zavodu za dječju kirurgiju KBC Split. Od ukupno 228 bolesnika, bilo je 80 djevojčica (35%) i 148 dječaka (65%). Odnos muške prema ženskoj djeci bio je 1,85 : 1. Od ukupno 228 hidronefroza, lijevostrana hidronefroza nađena je u 145 bolesnika, desnostrana u 62, a obostrana u 21 bolesnika. Od ukupnog broja bolesnika, njih 133 (58%) endoskopski je liječeno implantacijom „double J“ proteze, njih 74 (32%) operacijom po Hynes - Andersonu, a postupku nefrektomije podvrgnuto je 14 djece (6%). Udio bolesnika koji je nakon implantacije proteze podvrgnut operacijskom postupku iznosio je 27% (36 bolesnika). Ostali, manje zastupljeni postupci bili su pijelo/ureterostome (5 bolesnika, tj. 2,2%), resekcije krvnih žila koje su bile uzrokom hidronefroze (1 bolesnik) te nefropeksija (1 bolesnik). Od komplikacija zabilježene su simptomatske infekcije, recidivi stenoze, promjene proteze, migracije u bubrežnu nakapnicu i mokraćni mjehur, progresija hidronefroze, spontano ispadanje proteze, krvarenje i perforacija nakapnice.
Zaključci: Svaku hidronefrozu u novorođenčadi i djece predškolske dobi trebalo bi započeti liječiti endoskopski obzirom da je implantacija „double J“ proteze minimalno - invazivan zahvat kojim u čak 73% djece uspješno zbrinjavamo hidronefrozu, bez potrebe za klasičnim kirurškim zahvatom, a u ostalih „kupujemo“ vrijeme do definitivnog kirurškog zahvata. |
| Sažetak (engleski) | Aims of the study: Aims of the study: Aims of the study: Aims of the study:Aims of the study: Aims of the study: Aims of the study: To determine the demographic and clinical characteristics in children operated because of hydronephrosis in the Department of Pediatric Surgery, Split University Hospital from December 1990 to December 2014.
Patients and Methods: From December 1990 to December 2014 the medical history of 228 patients treated for hydroneprosis were retrospectively reviewed. Exclusion criteria were patients treated conservatively, patients with ureterohydronephrosis as those whose data were incomplete. The mean age of children was 4 years (range 0 - 18 years). Mean hospital stay was 8 days (range 3 - 22 days). The age, sex, lateralization, the success of treatment of hydronephrosis and complications were analyzed.
Results: In the current study period, the study included 228 patients treated for hydronephrosis by endoscopic implantation of „double J“ prosthesis, Hynes - Anderson pyeloplasty, nephrectomy and other less common procedures. Of the total number of patients, there were 80 girls (35%) and 148 boys (65%). The ratio of male to female children was 1,85: 1. Left - sided hydronephrosis was found in 145 patients, right - sided in 62, and bilateral in 21 patients. Of the total number of patients, 133 (58%) were treated with endoscopic implantation of „double J“ prosthesis, 74 of them (32%) had Hynes - Anderson pyeloplasty, and nephrectomy was performed in 14 children (6%). The proportion of patients who underwent operating procedure after prosthesis implantation was 27% (36 patients). Other, less common procedures were ureterostomy (5 patients; 2,2%), resection of the blood vessels (1 patient) and nephropexy (1 patient). These complications have been reported: symptomatic infections, recurrence of stenosis, changes of prosthesis, migration in the renal pelvis and bladder, progression of hydronephrosis, spontaneously prolapse of prothesis, bleeding and perforation of the pelvis.
Conclusions: Every hydronephrosis in infants and preschool children should be treated endoscopically considering that implantation of „double J“ prothesis is minimally invasive procedure that successfully resolves hydronephrosis in 73% of children, without the need for conventional surgery, and in other children we only „ buy“ time to definitive surgery. |
