机器人单孔+1腹腔镜与单孔腹腔镜肾盂成形术治疗肾盂输尿管连接部梗阻患儿的疗效比较  

Comparison of robotic-assisted single-incision-plus-one-port laparoscopic pyeloplasty and single-incision laparoscopic pyeloplasty in the treatment of pediatric ureteropelvic junction obstruction

作　　者：李鋆 陈荆艺 贾金富 何少华[1] 徐迪[1] Li Jun;Chen Jingyi;Jia Jinfu;He Shaohua;Xu Di(Department of Pediatric Surgery,Fujian Provincial Hospital,Provincial Clinical Medical College of Fujian Medical University,Fuzhou 350001,China)

机构地区：[1]福建医科大学省立临床医学院,福建省立医院小儿外科,福州350001

出　　处：《中华医学杂志》2024年第5期371-376,共6页National Medical Journal of China

基　　金：福建省2022年省级临床重点专科建设项目

摘　　要：目的比较机器人单孔+1腹腔镜肾盂成形术(R-SILP+1)与单孔腹腔镜肾盂成形术(SILP)治疗肾盂输尿管连接部梗阻患儿(UPJO)的疗效。方法回顾性分析2020年10月至2022年9月福建省立医院小儿外科接受手术治疗的47例UPJO患儿的临床资料,根据家长选择的手术方式,将患儿分为R-SILP+1组和SILP组。比较两组患儿基线资料、手术时间、术中吻合时间、术中出血量、术后住院时间、并发症、总费用、手术前后肾实质厚度(PT)、肾盂前后径(APD)、患侧分肾功能(DRF)等,评价两种术式的临床疗效。结果47例UPJO患儿中,R-SILP+1组27例,男16例,女11例,年龄(6.6±3.5)岁;SILP组20例,男12例,女8例,年龄(6.5±3.5)岁。两组患儿手术均获得成功,无中转开放手术。两组患儿基线资料、术中出血量、并发症、术后6个月APD、PT及术后12个月APD、PT、DRF差异均无统计学意义(均P>0.05)。与SILP组相比,R-SILP+1组患儿的手术时间[(153.0±14.4)比(189.9±32.6)min,P<0.001]、术中吻合时间[(68.8±16.8)比(97.5±12.0)min,P<0.001]及术后住院时间均较短[(6.0±1.3)比(9.0±1.3)d,P<0.001],但总费用较高[(57390±7664)比(30183±4219)元,P<0.001]。结论与SILP相比,R-SILP+1治疗小儿UPJO能够取得相当的疗效,在缩短手术时间、术中吻合时间、术后住院天数方面具有一定优势,但费用较高。Objective To compare the efficacy of robotic-assisted single-incision-plus-one-port laparoscopic pyeloplasty(R-SILP+1)with single-incision laparoscopic pyeloplasty(SILP)in pediatric ureteropelvic junction obstruction(UPJO).Methods The clinical data of 47 children with UPJO who underwent surgery from October 2020 to September 2022 in the Department of Pediatric Surgery of Fujian Provincial Hospital were retrospectively analyzed.According to the surgical method chosen by parents,the children were divided into R-SILP+1 group and SILP group.Baseline data,operative time,intraoperative anastomosis time,volume of blood loss,postoperative hospitalization time,complications,total costs,preoperative and postoperative renal parenchymal thickness(PT),anterior posterior diameter of renal pelvis(APD),and differential renal function(DRF)before and after operation were compared between the two groups,and the clinical efficacy of the two kinds of operation was evaluated.Results Among the 47 children,27 were in R-SILP+1 group,including 16 males and 11 females,aged(6.6±3.5)years;20 were in SILP group,including 12 males and 8 females,aged(6.5±3.5)years.The operations were successful in both groups without conversion to open operation.There were no significant differences between the two groups in baseline data,volume of blood loss,complications,APD and PT at postoperative 6 months,APD,PT and DRF at postoperative 12 months(all P>0.05).Compared with the SILP group,the operative time[(153.0±14.4)vs(189.9±32.6)minutes,P<0.001],intraoperative anastomosis time[(68.8±16.8)vs(97.5±12.0)minutes,P<0.001],postoperative hospitalization time[(6.0±1.3)vs(9.0±1.3)d,P<0.001]were shorter,but the total cost was higher[(57390±7664)vs(30183±4219)yuan RMB,P<0.001].Conclusions Compared with the SILP group,R-SILP+1 can achieve considerable efficacy in treating pediatric UPJO,and has certain advantages in shortening operative time,intraoperative anastomosis time,and postoperative hospitalization time.However,the cost is high.

关 键 词：输尿管梗阻 肾盂输尿管连接部梗阻 腹腔镜肾盂成形术 机器人 单孔+1 单孔腹腔镜技术 

分 类 号：R726.9[医药卫生—儿科]