肾盏造瘘技术在小婴儿重度肾积水腹腔镜肾盂成形术中的应用  

Application of Kidney Calices Fistulation in Laparoscopic Pyeloplasty in Infants With Severe Hydronephrosis

作　　者：胡岩[1] 李佳玉 高洁 齐灿[1] 高栩 高靖达 郭付臣[1] 刘侠 Hu Yan;Li Jiayu;Gao Jie(Department of Urology,Hebei Children's Hospital,Shijiazhuang 050031,China)

机构地区：[1]河北省儿童医院泌尿外科,石家庄050031 [2]首都医科大学附属北京友谊医院心内科,北京100050

出　　处：《中国微创外科杂志》2018年第12期1133-1136,共4页Chinese Journal of Minimally Invasive Surgery

摘　　要：目的探讨小婴儿重度肾积水行腹腔镜肾盂成形术中输尿管双J管置入失败,应用肾盏造瘘替代输尿管双J管引流的效果。方法 2016年4月～2017年6月6例小婴儿重度肾积水肾盂成形术中放置输尿管双J管失败,经肾盏留置吻合口支架管和肾盂造瘘管,替代输尿管双J管的引流作用。术后2～3周拔除吻合口支架管,夹闭肾盂造瘘管行亚甲蓝排泄试验阴性后拔除肾盂造瘘管。结果 6例患儿术中行肾盏造瘘,顺利留置吻合口支架管和肾盂造瘘管,术后肾盂造瘘管引流通畅。拔除吻合口支架管,夹闭肾盂造瘘管和拔管后患儿均无发热、呕吐及哭闹不适。4例术后1、3、6、12个月随访,超声或CT示肾积水明显减轻(肾盂前后径<1 cm,肾盏扩张<0. 5 cm),肾皮质逐渐增厚至0. 5～1. 0 cm(术前肾皮质最薄处仅1mm),肾脏形态接近正常; 2例患儿术后6个月复查肾核素扫描示分肾功能接近正常,分别为47. 3%、48. 2%(分肾功能50%为正常)。结论肾盏造瘘技术在小婴儿重度肾积水腹腔镜肾盂成形术中的辅助作用确切,效果良好。Objective To explore the effect of the replacement of ureteral double J tube drainage with pelvis fistulation in laparoscopic pyeloplasty in infants with severe hydronephrosis when failed double J tube drainage.Methods From April 2016 to June 2017,there were 6 infants with severe hydronephrosis underwent failed ureteral double J tube placement during laparoscopic pyeloplasty.The anastomotic stent tube and the pyelostomy tube were inserted through renal calyx to replace the supporting and drainage role of ureteral double J tube.After 2-3 weeks,the anastomotic stent tube was removed.And the pyelostomy tube was also removed after negative results of methylene blue excretion test.Results Six infants were treated with pelvis fistulation.The posting of the anastomotic stent tube and the pyelostomy tube went on well with effective drainage.After the removal of the anastomotic stent tube and the occlusion of the pyelostomy tube,no discomforts like fever,vomiting or crying appeared.Four cases were followed up after surgery at 1,3,6,and 12 months,which showed obviously relieved dropsy of the affected renal pelvis and renal calyces under ultrasonography or CT scanning(anteroposterior diameter of renal pelvis<1 cm,calyx dilatation<0.5 cm).The external form of the kidney was near-normal and the renal cortex obviously increased to 0.5-1.0 cm(preoperative renal cortex only 1 mm for the thinnest).Renal radionuclide scanning at 6 months after operation showed that renal function was close to normal in 2 infants(47.3%and 48.2%).Conclusion Pelvis fistulation in laparoscopic pyeloplasty in infants with severe hydronephrosis has exact and good effects.

关 键 词：腹腔镜 肾盏 造瘘 肾积水 小婴儿 

分 类 号：R726.9[医药卫生—儿科]