微创技术在小儿巨大肾积水保肾治疗中的临床应用  

Application of minimally invasive pyeloplasty in kidney preservation for the treatment of giant hydronephrosis

作　　者：谢起根 徐哲[1] 谢钧韬[1] 高文宗[1] 李作青[1] 周李[1] 

机构地区：[1]中山大学附属第一医院小儿外科,广州510080

出　　处：《中华腔镜泌尿外科杂志（电子版）》2017年第6期10-13,共4页Chinese Journal of Endourology(Electronic Edition)

基　　金：广东省科技计划社会发展项目(2012B031800297)

摘　　要：目的探讨腹腔镜下离断式肾盂输尿管整形术(LP)和达芬奇机器人辅助腹腔镜下离断式肾盂输尿管整形术(RALP)等微创技术在肾盂输尿管连接部梗阻(UPJO)合并巨大肾积水的保肾治疗中的应用价值。方法收集2015年8月至2016年7月期间中山大学附属第一医院小儿外科收治3例UPJO合并积水>1 000 ml的巨大肾积水患儿资料,患儿均于肾造瘘1个月后再行微创离断式UPJ成形术(2例RALP,1例LP)。术后定期随访,评估患肾形态及功能改善情况。总结其临床治疗经验。结果 3例患者微创UPJ成形手术时间为分别为180 min、147 min和205 min。2例术后恢复良好,1例RALP手术后出现吻合口狭窄经开放手术治愈。3例术后肾积水程度及范围较术前明显减轻,肾皮质厚度、肾小球滤过率和分肾功能较术前明显增加,患肾形态及功能恢复良好。结论微创技术治疗小儿巨大肾积水创伤小,注意防治吻合口狭窄,保证术后吻合口通畅的情况下肾脏形态和功能恢复好。Objective To evaluate the application of laparoscopic pyeloplasty （LP） and robot assisted laparoscopic pyeloplasty （RALP） in kidney preservation for the treatment of ureteropelvic junction obstruction （UPJO） with giant hydronephrosis. Methods Data of 3 children with UPJO and giant hydronephrosis （〉1000 ml） from August 2015 to July 2016 in the First Affiliated Hospital of Sun Yat-sen University were collected. All patients underwent preoperative nephrostomy and followed with minimally invasive Anderson-Hynes pyeloplasty （2 cases of RALP, 1 case of LP） one month after nephrostomy. All patients were followed up regularly to evaluate the improvement of renal morphology and function. Clinical treatment experiences were analyzed. Results The operation time of pyeloplasty was 180 min, 147 min and 205 min respectively in the three patients. Two cases recovered excellently, one case who underwent RALP appeared anastomotic stenosis and cured with open pyeloplasty. Hydronephrosis alleviated and the postoperative renal cortical thickness, glomerular filtration rate （GFR） and split renal function （SPF） increased significantly compared with preoperative results in all patients. The renal morphology and function improved excellently. Conclusions Minimally invasive pyeloplasty acquires little trauma in treatment of giant hydronephrosis, and the renal morphology and function can also improve excellently if inflammatory stricture is avoided and anastomotic patency is ensured.

关 键 词：肾积水 肾盂输尿管成形术 微创 保肾 机器人 

分 类 号：R726.9[医药卫生—儿科]