摘要
目的 总结机器人辅助腹腔镜肾盂成形术在小儿小肾盂,即肾盂前后径(anteroposterior diameter,APD)<2.5 cm的输尿管肾盂连接部梗阻(ureteropelvic junction obstruction,UPJO)患儿中的应用经验。方法 回顾性分析2018年3月至2019年10月收治的行达芬奇机器人辅助腹腔镜下肾盂成形术(robotic-assistant laparoscopic pyeloplasty,RALP)的12例小肾盂UPJO患儿的临床资料。其中,男7例,女5例;年龄4~15岁,平均7岁;患侧为左侧9例,右侧3例。术前1~7 d患儿B型超声检查提示APD<2.5 cm,术前核磁共振或CT尿路造影均提示为输尿管肾盂连接处梗阻,过往腹痛时期本院或当地超声检查示APD>3.5 cm。核素检查提示患儿患肾功能有不同程度的下降,患肾分肾功能在6%~43%。结果 12例RALP手术均顺利完成,无中转开放手术者。其中3例为单纯扭曲狭窄所致UPJO,3例为输尿管肾盂连接部(ureteropelvic junction,UPJ)处息肉的病变,4例为异位血管压迫,1例为UPJ处结石嵌顿伴感染,1例为腔静脉后输尿管。手术时间115~225 min,平均165 min;其中输尿管肾盂吻合时间40~60 min,平均50 min。术中无合并症,平均出血量<10 ml。患儿随访2~22个月,平均12个月。本组术后APD为(1.16±0.82)cm,与术前(1.87±0.57)cm比较,差异有统计学意义(P<0.05)。结论 机器人辅助腹腔镜下肾盂成形术可在小儿小肾盂UPJO中应用并能取得较好结果,操作相对较易掌握,临床应用前景较好。
Objective To summarize the experience of robotic-assistant laparoscopic pyeloplasty(RALP)for ureteropelvic junction obstruction(UPJO)with small pelvis in children.Methods A retrospective analysis was performed on clinical data of 12 UPJO children(small pelvis)undergoing RALP from March 2018 to October 2019.Their clinical presentations,operative approaches and follow-up data were analyzed.There were 7 boys and 5 girls with a mean age of 7(4-15)years.The involved side was left(n=9)and right(n=3).Ultrasound at 1-7 days preoperatively indicated anterioposterior diameter(APD)<2.5 cm and magnetic resonance urography or computed tomography urogram(MRU/CTU)indicated obstruction at ureteropelvic junction.Ultrasound indicated APD>3.5 cm during an on set of abdominal pain.And radionuclide examination hinted at different declining levels of renal function and the function of affected kidney ranged from 6%to 43%.Results RALP was performed all successfully without a conversion into open surgery.The pathogenesis was simple stricture or torsion(n=3),polyps(n=3),ectopic vascular compression(n=4),calculus incarceration with infection(n=1)and postcaval ureter(n=1).The average operative duration was 165(115-225)min and the average ureteropelvic anastomosis time 50(40-60)min.There were no obvious intraoperative complications and the mean volume of blood loss was<10 ml.The average follow-up period was 12(2-22)months.The mean preoperative value of APD was(1.87±0.57)cm and the mean postoperative value of APD(1.16±0.82)cm(P<0.05).Conclusions Robot-assisted laparoscopic pyeloplasty may be employed for pediatric UPJO with small renal pelvis(APD<2.5 cm).Such a technique is easy to learn and clinical application prospects are excellent.
作者
陶畅
唐达星
徐哲明
孙珑
高志刚
陈青江
舒强
Tao Chang;Tang Daxing;Xu Zheming;Sun Long;Gao Zhigang;Chen Qingjiang;Shu Qiang(National Clinical Research Center for Children's Health,epartment of Urology,Zhejiang Children's Hospital,Medical School of Zhejiang University,Zhejiang Clinical Research Center of Mini-invasive Diagnosis&Treatment of Abdominal Diseases,Hangzhou 310006,China)
出处
《中华小儿外科杂志》
CSCD
北大核心
2020年第3期205-209,共5页
Chinese Journal of Pediatric Surgery
基金
国家重点研发计划(2018YFC1002700)。
