摘要
目的 探讨腹腔镜输尿管输尿管端侧吻合术治疗小儿重复肾的安全性和有效性。方法 回顾性分析2020年6月~2021年12月9例重复肾上组肾积水行腹腔镜输尿管输尿管端侧吻合术的临床资料。年龄3个月~8岁(中位年龄7个月)。左侧6例,右侧2例,1例双侧重复肾伴左侧上组肾积水。2例术前检查提示上组肾对应输尿管异位开口于阴道或膀胱颈部,6例伴输尿管末端膨出。先行膀胱镜检查及患侧下组肾输尿管内双J管置入,于下组肾输尿管远端行腹腔镜输尿管输尿管端侧吻合。结果 9例均顺利完成腹腔镜手术,无中转开放手术。术中无并发症,术中出血量<10 ml。手术时间180~240(202.2±21.1)min。住院时间7~10(8.5±0.9)d。术后4~6周拔除双J管,2例双J管留置期间尿路感染。9例术后随访6~21(11.7±5.1)月,复查超声均提示上组肾积水较前减轻,7例上组肾扩张的输尿管直径较前缩小。一例8岁女性患儿术前输尿管异位开口存在尿失禁,术后症状完全消失。结论 初步经验表明腹腔镜输尿管输尿管端侧吻合术对小儿重复肾是一种安全、有效的术式选择。
Objective To investigate the efficacy and safety of laparoscopic ureteroureterostomy in the management of duplex collecting systems in children. Methods A retrospective review of 9 patients who underwent laparoscopic ureteroureterostomy at our institution between June 2020 and December 2021 was performed. The age ranged from 3 months to 8 years old(median, 7 months old). There were 6 cases of left-sided and 2 cases of right-sided duplex colleting systems, and the other one patient had bilateral duplex collecting system with left-sided upper pole hydronephrosis. Two of the patients were found to have ectopic upper pole ureters draining either into the vagina or bladder neck. Ureterocele was present in 6 cases. Cystoscopy and double J stent placement into the lower pole ureter were performed at the beginning of all the cases. Laparoscopic end-to-side ureteral anastomosis was carried out along the distal lower pole ureter. Results Laparoscopic ureteroureterostomy was completed in 9 patients without conversion to open surgery. There were no intraoperative complications and the blood loss was less than 10 ml. The operative duration was 180-240 min(mean, 202.2±21.1 min), which included the time to perform the cystoscopy and double J stent placement. The hospital stay was 7-10 d(mean, 8.6±0.9 d). The double J stents were removed after 4-6 weeks. Two children presented with febrile urinary tract infection(UTI) while still having a double J stent in place. The follow-up duration was 6-21 months(mean, 11.7±5.1 months). All the patients demonstrated improved hydronephrosis and 7 patients demonstrated improved ureteral dilation under ultrasound review. An eight-year-old girl who presented with incontinence was completely dry. Conclusion Laparoscopic ureteroureterostomy with end-to-side anastomosis is a safe and effective manner in the treatment of duplex collecting systems in children.
作者
程时刚
吕泽民
袁祖森
向旋
毛晓雯
林松
耿红琼
杨星海
Cheng Shigang;Lv Zemin;Yuan Zusen(Department of Surgery,Maternal and Child Health Hospital of Hubei Province,Tongji Medical College,Huazhong University of Science and Technology,Wuhan 430070,China)
出处
《中国微创外科杂志》
CSCD
北大核心
2023年第2期135-139,共5页
Chinese Journal of Minimally Invasive Surgery
基金
第二届医学领军人才工程培养对象暨湖北名医工作室(1020012401)。
