经脐腹腔镜肾盂成形术治疗婴儿重度肾积水135例  

Transumbilical laparoscopic pyeloplasty in the treatment of infants younger than 3 months with severe hydronephrosis

作　　者：郑清友[1] 周辉霞[1] 马立飞[1] 周晓光[1] 谢华伟[1] 陶天[1] 王超[1] 

机构地区：[1]北京军区总医院附属八一儿童医院泌尿外科,北京100700

出　　处：《临床军医杂志》2015年第9期881-884,共4页Clinical Journal of Medical Officers

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

摘　　要：目的：探讨经脐腹腔镜肾盂成形术治疗3个月以下婴儿重度肾积水的可行性及安全性。方法回顾性分析自2011年6月至2014年6月,我科收治的3个月以下婴儿重度肾积水患儿135例的临床资料。其中,男性96例,女性39例,均由产前超声检查检出,肾盂前后径均＞3.0 cm,出生后经超声及磁共振水成像（ MRU）证实,放射性核素扫描（ ECT）患侧分肾肾小球滤过率（GFR）均＜40 ml/min。采用经脐单孔（72例）及多孔（63例）入路腹腔镜离断式肾盂成形术。结果全部患儿手术过程均顺利,无中转开放或另外增加Trocar,未出现围术期并发症。手术平均时间（81.25±14.32）min,术中平均出血量（7.75±4.0）ml,术后平均住院时间（7.22±1.09）d。随访3～36个月,127例患肾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。4例术后肾积水稳定,未见加重,另外4例术后再次狭窄行二次手术好转。结论经脐腹腔镜肾盂成形术治疗婴儿重度肾积水安全可行,效果确切,美容效果良好。Objective To explore the feasibility and the safety of transumbilical laparoscopic pyeloplasty for the treatment of infants younger than 3 months with severe hydronephrosis due to renal pelvis ureteral junction obstruction （ PUJO） . Methods We retrospec-tively reviewed 135 infants younger than 3 months with severe hydronephrosis who underwent transumbilical laparoscopic pyeloplasty （single-port for 63,multi-port for 72） from June 2011 to June 2014. The median age was 52 （5-90） days. All cases were detected by prenatal ultrasound and renal pelvis anteroposterior diameter were more than 3. 0 cm. Ultrasound were repeated and magnetic resonance urography （MRU） were performed in all patients in 1-2 weeks after births. Emission computed tomography（ECT） showed that split function of hydronephrotic kidneys were lower than 40%. Results The operation process were successfully performed in all patients. There was no conversion, requirement of additional trocar placement or intraoperative complication. The median operative time was 84. 6 （81. 25 ± 14. 32） min. The patients were followed up from 3 to 36 months with ultrasound and ECT. The anastomoses were proved to be patent,the renal parenchymal thickness increased. The renal pelvic anteroposterior diameters were reduced and the renal functions were improved in 127 patients. In addition,the scar was not obvious. Renal hydronephrosis were stable after operation in 4 pa-tients,and other 4 were performed second operation because of stenosis. Conclusion Transumbilical laparoscopic pyeloplasty for in-fants younger than 3 months with severe hydronephrosis is feasible,safe and minimally invasive.

关 键 词：经脐 腹腔镜 肾盂输尿管成形术 肾积水 婴儿 

分 类 号：R726.9[医药卫生—儿科]