机器人辅助腹腔镜同期处理小儿双侧肾盂输尿管连接部梗阻的初步经验  

Preliminary experience of applying robotic-assisted laparoscopic pyeloplasty for bilateral ureteropelvic junction obstructions in children

作　　者：陶天 周辉霞 李品 曹华林 郭涛 朱炜玮 赵扬 周晓光 马立飞 Tao Tian;Zhou Huixia;Li Pin;Cao Hualin;Guo Tao;Zhu Weiwei;Zhao Yang;Zhou Xiaoguang;Ma Lifei(Department of Pediatric Urology,Bayi Children's Hospital,Affiliated Seventh Medical Center of PLA General Hospital,Beijing 100700,China)

机构地区：[1]中国人民解放军总医院第七医学中心附属八一儿童医院泌尿外科,北京100700

出　　处：《中华小儿外科杂志》2020年第3期193-196,共4页Chinese Journal of Pediatric Surgery

基　　金：军队计生专项(18JS001);北京市科技计划(Z181100001718008)。

摘　　要：目的 总结双侧肾盂输尿管连接部梗阻(ureteropelvic junction obstruction,UPJO)患儿同期行机器人辅助腹腔镜手术的临床经验,并对治疗效果进行评估。方法 回顾性分析2017年6月至2019年5月就诊的6例行机器人辅助腹腔镜双侧肾盂成形术的双肾重度积水患儿的临床资料。其中,男4例,女2例;年龄(65.8±34.2)个月。所有患儿术前均行泌尿系统超声、磁共振泌尿系统水成像、利尿肾动态显像及排泄性尿路显像明确诊断。术前超声结果显示患儿左侧肾盂前后径为(3.07±0.67)cm,右侧为(3.22±0.51)cm。手术方法采用机器人辅助腹腔镜技术左右侧顺次行肾盂成形术。结果 6例患儿手术均获得成功,无中转开放手术患儿,无术中并发症。手术时间为(246.17±23.02)min,出血量为(29.17±6.07)ml,无Clavien-Dindo Ⅲ级以上并发症出现。术后3个月复查超声显示患儿左侧肾盂前后径为(1.37±0.25)cm,右侧为(1.47±0.19)cm,手术前、后两侧肾盂前后径比较,差异均有统计学意义(P<0.01)。术后6个月复查利尿性肾动态显像,6例均提示无梗阻。结论 机器人辅助腹腔镜同期处理小儿双侧肾盂输尿管连接部梗阻安全有效,并具有缩短手术恢复期、节约手术费用、提高美容效果、有效降低患儿心理及经济压力的优势。Objective To summarize the experience and efficacy of robot-assisted bilateral laparoscopic pyeloplasty for children with bilateral ureteropelvic junction obstruction(UPJO).Methods Robot-assisted bilateral laparoscopic pyeloplasty was performed for 6 children with bilateral severe hydronephrosis from June 2017 to May 2019.There were 4 boys and 2 girls with an average age of(65.8±34.2)months.Ultrasound,magnetic resonance urography(MRU),diuretic renal dynamic imaging and voiding cystourethrogram(VCUG)were performed.The left/right-side preoperative anterioposterior diameter(APD)was(3.07±0.67)and(3.22±0.51)cm respectively.Then robotic-assisted bilateral laparoscopic pyeloplasty was performed.Results All operations were successful.There was no intraoperative complication.The mean operative duration was(246.17±23.02)min and the mean volume of estimated blood loss was(29.17±6.07)ml.No complications of Clavien-Dindo gradeⅢ/Ⅳoccurred.The mean follow-up period was(16.5±8.92)months.The left/right-side postoperative APD was(1.37±0.25)and(1.47±0.19)cm respectively.The statistical difference was significant.All renal functions were normal.Conclusions Robotic-assisted bilateral laparoscopy pyeloplasty is both feasible and safe.It provides an effective method of managing patients with bilateral UPJO.

关 键 词：儿童 肾盂输尿管连接部梗阻 机器人辅助腹腔镜手术 

分 类 号：R726[医药卫生—儿科] TP242[医药卫生—临床医学]