经脐多切口腹腔镜肾盂成形术治疗新生儿重度肾积水  

Preliminary experience of using transumbilical multi-stab technique in laparoscopic pyeloplasty for new- borus

作　　者：周辉霞[1] 谢华伟[1] 马立飞[1] 周晓光[1] 陶天[1] 申州[1] 马斯超[1] 李龙[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]首都儿科研究所外科

出　　处：《中华小儿外科杂志》2013年第11期830-833,共4页Chinese Journal of Pediatric Surgery

基　　金：北京市科技计划（Z11110706730000）;中国博士后基金（201104901908）

摘　　要：目的探讨经脐多切口腹腔镜。肾盂成形术治疗新生儿重度肾积水（肾盂输尿管连接部梗阻PUJO）可行性、安全性及初步经验分析。方法本组患儿21例，为2009年6月至2012年6月收治的新生儿肾积水，其中男14例，女7例，左侧14例，右侧5例，双侧2例；本组病例入选标准：均由产前超声检出，肾盂前后径均大于3cm，出生1周后查患侧分。肾功能低于40％；均采用经脐多切口腹腔镜离断式肾盂成形术。结果21例患儿手术均获成功，无中转开放或另外增加Trocar，无术中并发症。单侧平均手术时间75min，双侧平均手术时间185min，术中平均出血量〈10m1，术后平均住院时间9d。术后采用超声、放射性核素扫描随访6～36个月，均显示吻合口通畅，。肾实质均有不同程度增厚，肾盂前后径均明显减小，患肾分肾功能不同程度恢复，术后瘢痕不明显，8例术后肾盂前后径〈1．0cm，形态接近正常。结论经脐多切口腹腔镜肾盂成形术治疗新生儿重度肾积水安全可行，创伤小，恢复快，疗效好，美容效果良好，值得推广。Objective To investigate the feasibility and safety of laparoscopic pyeloplasty for treatment of newborns with ureteropelvic junction obstruction （UPJO）. Methods Twenty-one new- borns （14 males and 7 females） with hydronephrosis from June 2009 to June 2012 were enrolled in the study. Among them, 14 patients had left hydronephrosis, 5 had right hydronephrosis, and 2 had bi- lateral hydronephrosis. The criteria for surgery were： ①hydronephrosis with pelvic anteroposterior di- ameter greater than 3 cm on prenatal uhrasound; ②ipsilateral renal function less than 40% when ex- amined a week after birth. These patients were treated through multi-incision transumbilical laparo- scopic dismembered pyeloplasty technique. Results All 21 patients had successful operation with no conversion and no intraoperative complication. The mean operative time was 75 min for patients with unilateral hydronephrosis and 185 min for patients with bilateral hydronephrosis. The mean intraoper- ative blood loss was less than 10 ml. The mean hospital stay was 9 days. Length of follow up of the patients varied from 6 to 36 months using ultrasound and radionuclide scans. These showed anasto- motic patency, varying degree of renal parenchyma thickening, significantly reduced renal pelvic an- teroposterior diameter and varying degrees of renal function recovery. In addition, the operative scars were not obvious. Conclusions Transumbilical laparoscopic pyeloplasty for newborns is feasible, safe and less invasive and has better cosmetic outcomes.

关 键 词：腹腔镜 肾盂 新生儿 肾盂积水 

分 类 号：R726.9[医药卫生—儿科]