腹腔镜下重复输尿管端侧吻合术治疗重复肾的疗效分析  

Efficacy of laparoscopic end-to-side ureterostomy for duplicate kidney

作　　者：桂萌 张磊[1] 贺庆豹 王浩[1] 张玲玲[1] 贺红嘉 李开升[1] Gui Meng;Zhang Lei;He Qingbao;Wang Hao;Zhang Lingling;He Hongjia;Li Kaisheng(Department of Mini-Invasive Urology,Affiliated Municipal Children's Hospital,Shandong University,Jinan 250022,China)

机构地区：[1]山东大学附属儿童医院(济南市儿童医院)泌尿微创外科,济南250022

出　　处：《临床小儿外科杂志》2024年第5期469-473,共5页Journal of Clinical Pediatric Surgery

摘　　要：目的评价腹腔镜下重复输尿管端侧吻合术治疗完全型重复肾上输尿管扩张或异位开口的临床疗效。方法回顾性分析2018年10月至2022年8月山东大学附属儿童医院采用腹腔镜下重复输尿管端侧吻合术治疗的23例完全型重复肾患儿临床资料。女14例、男9例,年龄15(8,26)个月。主要临床表现为漏尿、发热性尿路感染。测量手术前后上肾肾盂前后径以及上输尿管直径,观察手术疗效及并发症。结果23例均在腹腔镜下成功完成手术并获得完整随访。手术时间100(90,120)min,术后留置输尿管支架36(32,41)d。术后所有患儿漏尿症状消失,无一例出现发热性尿路感染。所有患儿手术前后血压均正常,手术前后无一例出现下输尿管扩张。术前上肾盂前后径(15.22±9.19)mm,上输尿管最宽直径(13.91±5.98)mm;术后6个月上肾盂前后径(6.87±6.36)mm,上输尿管最宽直径(3.83±1.95)mm;手术前后上肾盂前后径、上输尿管最宽直径差异均有统计学意义(P<0.05)。结论腹腔镜下重复输尿管端侧吻合术治疗完全型重复肾上输尿病变疗效确切,操作简单,并发症少,值得推广。Objective To evaluate the clinical efficacy of laparoscopic repeat ureteral end-side anastomosis for complete repeat suprarenal ureteral dilatation or ectopic opening and summarize the related operational approaches and experiences.Methods From October 2018 to August 2022,the relevant clinical data were retrospectively reviewed for 23 children with complete duplex kidney undergoing laparoscopic end-to-side ureterostomy.There were 9 boys and 14 girls with a median age of 15(8-26)month.The major clinical manifestations included urinary leakage,febrile urinary tract infection and a combination of both.Anteroposterior diameter of upper renal pelvis and diameter of upper ureter were measured before and after operation.The curative outcomes and complications were recorded.Results All laparoscopic procedures were successfully performed and followed up completely.Operative duration was 100(90-120)min and ureteral stent indwelled for 36(32-41)days.After operation,all preoperative symptoms disappeared.Blood pressure remained normal before and after operation.There was no onset of lower ureteral dilatation before and after operation.Before operation,anteroposterior diameter of upper renal pelvis was(15.22±9.19)and the widest diameter of upper ureter(13.91±5.98);after operation,anteroposterior diameter of upper renal pelvis was(6.87±6.36)and the widest diameter of upper ureter(3.83±1.95).Anteroposterior diameter of upper renal pelvis and the widest diameter of upper ureter before and after operation were compared(P<0.05).The differences were statistically significant(P<0.05).None of them showed recurrent fever,abdominal pain or vomiting.No dilation occurred in lower ureter or lower renal pelvis.Conclusions Laparoscopic repeated end-to-side ureteroureterostomy is efficacious for children with complete repetitive upper ureteral lesions.As a simple operation with few complications,it is worthy of wider popularization.

关 键 词：腹腔镜 输尿管端侧吻合术 完全型重复肾 重复上输尿管扩张 外科手术 儿童 

分 类 号：R726.9[医药卫生—儿科]