经脐单切口腹腔镜与传统手术行小儿重复肾上肾切除术的比较  

Transumbilical laparoscopic versus conventional partial nephrectomy in children with kidney duplication anomalies

作　　者：汤梁峰[1] 刘颖[1] 沈剑[1] 陆良生[1] 王翔[1] 陆毅群[1] 阮双岁[1] 毕允力[1] 

机构地区：[1]复旦大学附属儿科医院泌尿外科,上海201102

出　　处：《中华小儿外科杂志》2015年第9期702-704,共3页Chinese Journal of Pediatric Surgery

基　　金：卫计委公益性行业科研专项（2014136）;国家临床重点专科建设项目（国卫办医函[2013]544号）

摘　　要：目的通过病例分析及随访，分析比较经脐单切口腹腔镜手术和传统腹腔镜及开放手术行上肾切除术的差异。方法回顾性分析2007年10月至2013年9月间因肾脏输尿管重复畸形就诊的87例患儿共88侧上肾切除术的临床资料。按不同手术方法分为经脐单切口腹腔镜组（37例）、传统腹腔镜组（14例）和开放手术组（37例），比较各组在手术时间、输血、术后引流情况、术后住院天数、术后发热天数、远期并发症等方面的差异。结果各组患儿年龄、体重、性别及左右侧比例比较，差异无统计学意义。经脐单切口腹腔镜组手术时间（184．9±56．9）min，与传统腹腔镜组（170．4±35．6）min比较，差异无统计学意义；与开放手术组（124．7±38．9）min比较，差异有统计学意义（P〈0．05）。经脐单切口腹腔镜组输血率为24．3％（9／37），高于开放手术组8．1％（3／37），差异有统计学意义（PdO．05）；与传统腹腔镜组14．2N（2／14）比较，差异无统计学意义。经脐单切口腹腔镜组术后负压球引流量、引流时间、术后发热天数、术后住院天数与传统腹腔镜组和开放手术组比较，差异均无统计学意义。术后早期发生手术区积液或囊肿的在经脐单切口腹腔镜组、传统腹腔镜组和开放手术组分别为4例、1例、4例，长期随访均消失。经脐单切口腹腔镜组和开放手术组各有1例出现输尿管残端感染，前者保守治疗好转，后者经手术切除残端后治愈。各组在随访期内未发现其他并发症。结论虽然经脐单切口腹腔镜重复上肾切除术手术时间较传统手术长、输血率偏高，但切口隐蔽、美观，且围手术期并发症及长期预后和传统手术无显著差异，可作为传统开放和腹腔镜手术的替代方案。Objective To compare the laparoscopy versus open surgery or conventional differences among transumbilical single incision laparoscopy for partial nephrectomy of kidney and ureter duplication. Methods Retrospective analyses and follow-ups were performed for 88 kidneys of 87 children undergoing partial nephrectomy from October 2007 to September 2013. Operative duration, blood transfusion, postoperative drainage, postoperative hospital stay, short and long-term complications were recorded. Results They were divided into transumbilical single incision laparoscopy （n= 37）, conventional laparoscopy （n = 14） and open surgery （n = 37） groups. Age, weight and proportion of left or right side involvement showed no significant difference between groups. The mean operative duration of transumbilical single incision laparoscopy group was （184. 9 ± 56. 9）min. And it had no difference with traditional laparoscopy group （170. 4 ± 35. 6） min, but longer than open surgery group （124. 7 ± 38.9） min. The transfusion rate of transumhilical single incision laparoscopic group （9/37, 24. 3%） was higher than that of open surgery group （3/37, 8. 1%）, but had no difference with conventional laparoscopy group （2/14, 14.2%）. No difference existed between groups in drainage amount, drainage time, days of postoperative fever or postoperative hospital stay. During early postoperative period, surgical area effusion or cyst in transumbilical single incision laparoscopic group （n = 4）, traditional laparoscopy group （n = 1） and open surgery group （n = 4） disappeared completely. No other complications occurred during long-term follow-ups. Conclusions With longer operative duration and higher blood transfusion rate, transumbilical single incision laparoscopy for partial nephrectomy of duplicated kidney is both safe, effective and aesthetic.

关 键 词：泌尿生殖系统畸形 输尿管 肾切除术 腹腔镜检查 

分 类 号：R726.9[医药卫生—儿科]