机器人辅助腹腔镜肾盂成形术在小儿小肾盂输尿管肾盂连接部梗阻中的应用  

Outcomes of robot-assisted laparoscopic pyeloplasty for ureteropelvic junction obstruction with small pelvis in children

作　　者：陶畅[1] 唐达星[1] 徐哲明[1] 孙珑 高志刚[1] 陈青江[1] 舒强[1] Tao Chang;Tang Daxing;Xu Zheming;Sun Long;Gao Zhigang;Chen Qingjiang;Shu Qiang(National Clinical Research Center for Children's Health,epartment of Urology,Zhejiang Children's Hospital,Medical School of Zhejiang University,Zhejiang Clinical Research Center of Mini-invasive Diagnosis&Treatment of Abdominal Diseases,Hangzhou 310006,China)

机构地区：[1]国家儿童健康与疾病临床医学研究中心,浙江大学医学院附属儿童医院泌尿外科,浙江省腹腔脏器微创诊治临床医学研究中心,杭州310006

出　　处：《中华小儿外科杂志》2020年第3期205-209,共5页Chinese Journal of Pediatric Surgery

基　　金：国家重点研发计划(2018YFC1002700)。

摘　　要：目的 总结机器人辅助腹腔镜肾盂成形术在小儿小肾盂,即肾盂前后径(anteroposterior diameter,APD)<2.5 cm的输尿管肾盂连接部梗阻(ureteropelvic junction obstruction,UPJO)患儿中的应用经验。方法 回顾性分析2018年3月至2019年10月收治的行达芬奇机器人辅助腹腔镜下肾盂成形术(robotic-assistant laparoscopic pyeloplasty,RALP)的12例小肾盂UPJO患儿的临床资料。其中,男7例,女5例;年龄4~15岁,平均7岁;患侧为左侧9例,右侧3例。术前1~7 d患儿B型超声检查提示APD<2.5 cm,术前核磁共振或CT尿路造影均提示为输尿管肾盂连接处梗阻,过往腹痛时期本院或当地超声检查示APD>3.5 cm。核素检查提示患儿患肾功能有不同程度的下降,患肾分肾功能在6%~43%。结果 12例RALP手术均顺利完成,无中转开放手术者。其中3例为单纯扭曲狭窄所致UPJO,3例为输尿管肾盂连接部(ureteropelvic junction,UPJ)处息肉的病变,4例为异位血管压迫,1例为UPJ处结石嵌顿伴感染,1例为腔静脉后输尿管。手术时间115~225 min,平均165 min;其中输尿管肾盂吻合时间40~60 min,平均50 min。术中无合并症,平均出血量<10 ml。患儿随访2~22个月,平均12个月。本组术后APD为(1.16±0.82)cm,与术前(1.87±0.57)cm比较,差异有统计学意义(P<0.05)。结论 机器人辅助腹腔镜下肾盂成形术可在小儿小肾盂UPJO中应用并能取得较好结果,操作相对较易掌握,临床应用前景较好。Objective To summarize the experience of robotic-assistant laparoscopic pyeloplasty(RALP)for ureteropelvic junction obstruction(UPJO)with small pelvis in children.Methods A retrospective analysis was performed on clinical data of 12 UPJO children(small pelvis)undergoing RALP from March 2018 to October 2019.Their clinical presentations,operative approaches and follow-up data were analyzed.There were 7 boys and 5 girls with a mean age of 7(4-15)years.The involved side was left(n=9)and right(n=3).Ultrasound at 1-7 days preoperatively indicated anterioposterior diameter(APD)<2.5 cm and magnetic resonance urography or computed tomography urogram(MRU/CTU)indicated obstruction at ureteropelvic junction.Ultrasound indicated APD>3.5 cm during an on set of abdominal pain.And radionuclide examination hinted at different declining levels of renal function and the function of affected kidney ranged from 6%to 43%.Results RALP was performed all successfully without a conversion into open surgery.The pathogenesis was simple stricture or torsion(n=3),polyps(n=3),ectopic vascular compression(n=4),calculus incarceration with infection(n=1)and postcaval ureter(n=1).The average operative duration was 165(115-225)min and the average ureteropelvic anastomosis time 50(40-60)min.There were no obvious intraoperative complications and the mean volume of blood loss was<10 ml.The average follow-up period was 12(2-22)months.The mean preoperative value of APD was(1.87±0.57)cm and the mean postoperative value of APD(1.16±0.82)cm(P<0.05).Conclusions Robot-assisted laparoscopic pyeloplasty may be employed for pediatric UPJO with small renal pelvis(APD<2.5 cm).Such a technique is easy to learn and clinical application prospects are excellent.

关 键 词：儿童 机器人辅助腹腔镜手术 肾积水 输尿管肾盂连接部梗阻 

分 类 号：R726[医药卫生—儿科] TP242[医药卫生—临床医学]