摘要
目的探讨腹腔镜肾盂成形术治疗新生儿肾盂输尿管连接部梗阻（PUJO）的可行性、安全性及初步经验分析。方法本组患儿11例，为2009年6月至2012年4月收治的肾积水新生儿，男9例，女2例，均由产前超声检出，肾盂前后径均〉3em，出生1周后复查放射性核素扫描（ECT），患侧肾功能均低于40％，均采用经脐入路腹腔镜离断式肾盂成形术。结果11例患儿手术均获成功，无中转开放手术或另外增加鞘管，无术中并发症。手术平均时间80min，术中平均出血量〈10mL，术后平均住院时间9d。术后采用超声、ECT随访6～36个月，均显示肾实质有不同程度增厚，肾盂前后径均明显减小，8例形态接近正常，另外3例肾盂前后径1．5cm左右，患侧。肾功能不同程度恢复，术后瘢痕不明显。结论腹腔镜肾盂输尿管成形术治疗新生儿肾积水安全可行，对肠道干扰不大，美容效果良好，值得推广，但需在熟练掌握腹腔镜缝合技术后逐步从大龄患儿过渡。
Objective To explore the feasibility and safety of laparoscopic pyeloplasty in the treatment of neo- natal renal pelvis ureteral junction obstruction （PUJO） , and to analyze its preliminary experience. Methods From Jun. 2009 to Apr. 2012,11 neonates（ 9 boys and 2 girls） were recruited in this study. They were all detected by prenatal ul- trasound and renal pelvis anteroposterior diameter was more than 3 cm. One week after birth, emission computed tomo- graphy （ECT） showed that split function of hydronephrotic kidneys were lower than 40%. All patients underwent laparo- scopic dismembered pyeloplasty. Results All successful underwent laparoscopic dismembered pyeloplasty, no conver- sion to open surgery or additional Trocar, no intraoperative complications. The mean time of operation was 80 rain, and blood loss was less than 10 mL,the mean postoperative hospital stay was 9 days. All patients were followed up for 6 to 36 months with ultrasound and ECT. The thickness of renal parenchyma increased, and 8 kidneys turned almost normal, the other＇s renal pelvis anteroposterior diameter was about 1.5 cm, renal pelvis anteroposterior was significantly re- duced, and the scar was not obvious. Conclusions Laparoscopic ureteroplasty in the treatment of neonatal hydrone- phrosis is safe and feasible, and it is worthy of application in a large scale. Operators need mastering laparoscopic suture technology, and then apply the technique from older children to neonates gradually.
出处
《中华实用儿科临床杂志》
CAS
CSCD
北大核心
2013年第5期387-389,共3页
Chinese Journal of Applied Clinical Pediatrics
基金
北京市科技计划（Z11110706730000）
中国博士后基金（201104901908）
