经脐单部位三通道腹腔镜治疗小儿上尿路疾病  

Transumbilical single-port laparoscopy for upper urinary tract pathologies in infants

作　　者：周辉霞[1] 孙宁[2] 谢华伟[1] 马立飞[1] 周晓光[1] 孟浩[1] 申州[1] 陶天[1] 黄澄如[2] 

机构地区：[1]北京军区总医院附属八一儿童医院泌尿外科,100700 [2]首都医科大学附属北京儿童医院泌尿外科

出　　处：《中华小儿外科杂志》2011年第7期515-518,共4页Chinese Journal of Pediatric Surgery

摘　　要：目的探讨经脐单部位三通道腹腔镜治疗小儿上尿路疾病手术的初步应用和体会。方法2010年9月共完成3例经脐单部位三通道腹腔镜手术，包括。肾盂输尿管成形术1例；重复肾重复输尿管切除术1例；乳头式输尿管膀胱再植术1例。结果全部手术均在单部位腹腔镜下成功完成，无需术中增加套管或开放手术，无术中并发症出现，估计平均出血量小于2（）ml，术中术后无输血。手术时间分别为：肾盂成形术200min、重复肾重复输尿管切除术85min、输尿管膀胱再植术160min。均于术后24h内恢复饮食，重复肾切除术后1d拔除引流管和尿管，肾盂成形术和输尿管膀胱再植术后2d拔除引流管，术后7d拔除尿管。分别于术后10d、5d、8d出院，肾盂成形术和输尿管膀胱再植术患儿均于术后1个月拔除双J管。术后3个月复查，肾盂成形术后患儿复查静脉尿路造影可见吻合口通畅，肾积水减轻；重复肾患儿复查彩超见残存的下肾血供良好，肾核素扫描示分肾功能好；输尿管膀胱再植术后复查静脉尿路造影及膀胱尿道造影未见吻合口狭窄和反流，脐部切口美观。结论经脐单部位三通道腹腔镜手术用于小儿泌尿外科毁损性和功能重建性手术安全、可行、手术瘢痕小且隐蔽，美容效果好。但因手术器械通道狭小，术中器械之间有相互干扰且活动范围小，使吻合比较困难，单部位腹腔镜重建性手术需谨慎开展。Objective To review our initial clinical experience of transumbilical single-port lapa- roscopy in infants with upper urinary tract diseases. Methods In June, 2010 , we performed transumbil- ical single-port laparoscopies in 3 patients, including 1 pyeloptasty, 1 heminephroureterectomy and 1 papillary type ureteral reimplantation. Results All cases were completed successfully. No additional trocar was used and no complications were observed. The mean blood loss was less than 20ml. The op- erative time was 200 min for pyeloplasty,85min for heminephroureterectomy and 160min for papillary type ureteral reimplantation, respectively. In the pyeloplasty case, the drainage tube and ureter were re- moved 1 day after surgery. In the last 2 cases, the drainage tubes were removed 2 days post-operatively and urinary catheters were removed 7 days post surgery,respectively. The patients were discharged on the 10th,Sth and 8th post operative day. Double-J ureteral stents were removed 1 month after surgery in the first two patients. After 3 month follow-up,the first patient showed significant alleviation in hy- dronephrosis, the low pole kidney of the second patient was well and MRU did not demonstrate any re- flux in the last patient. Conclusions Applying transumbilieal single-port laparoscopic technique in breakage and reconstruct surgery is safe and feasible, with the advantages of less trauma and more cos- metic benefit. However,more specific instruments are required to better apply the technique; difficul- ties still exist including, limited movement of instruments,suturing and knotting.

关 键 词：腹腔镜外科手术 上尿路疾病 

分 类 号：R726[医药卫生—儿科]