机器人辅助腹腔镜重复肾半肾切除术治疗小儿重复肾输尿管畸形的临床分析  

Clinical research of robot-assisted laparoscopic hemi-nephrectomy for children's complete duplex kidney

作　　者：周晓光 马立飞 陶天 曹华林 李品 周辉霞 Zhou Xiaoguang;Ma Lifei;Tao Tian;Cao Hualin;Li Pin;Zhou Huixia

机构地区：[1]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：《中华泌尿外科杂志》2020年第7期531-535,共5页Chinese Journal of Urology

基　　金：北京市科技计划(Z181100001718008);首都卫生发展科研专项(首发2016-2-5091)。

摘　　要：目的探讨机器人辅助腹腔镜重复肾半肾切除术治疗小儿重复肾输尿管畸形的临床效果。方法回顾性分析2017年3月至2019年11月解放军总医院第七医学中心附属八一儿童医院收治的20例重复肾输尿管畸形患儿的临床资料。男4例,女16例;年龄1~72个月,平均28.6个月。重复肾均位于肾上极,其中左侧9例,右侧11例。20例均有超声检查提示肾积水逐渐加重史,其中临床表现为腰腹部酸胀不适2例,排尿困难1例,尿失禁(正常排尿期外滴尿)2例,有泌尿系感染史12例,尿道外口囊性肿物脱出2例。术前完善磁共振泌尿系水成像、利尿性肾动态显像(ECT)、静脉肾盂造影、排尿性膀胱尿道造影检查确诊,其中伴输尿管异位开口2例,输尿管末端囊肿4例,重复输尿管反流4例。20例检查均提示重复上肾无功能,行机器人辅助腹腔镜重复肾半肾切除术。观察术中、术后并发症情况及随访结果。结果20例均顺利完成手术,术中、术后均未发生严重并发症。手术时间82~150 min,平均109.5 min;术中出血量5~22 ml,平均9 ml。术后胃肠功能恢复时间8~24 h,平均9.1 h,术后第2天恢复正常饮食。术后腹腔引流管放置时间2~4 d,平均2.7 d。住院时间4~8 d,平均5.9 d。术后1例失访,其余19例均门诊随访,随访时间3~30个月,平均13.6个月。术后3个月第1次复查ECT未提示下肾萎缩或功能丢失。2例伴有尿失禁者术后症状完全消失,2例有尿道口肿物者术后肿物未再出现,术前有排尿困难、腰腹部酸胀者术后症状消失。术后无漏尿发生。20例中,2例术后出现泌尿系感染,经抗感染治疗后治愈。结论机器人辅助腹腔镜重复肾半肾切除术治疗儿童重复肾输尿管畸形创伤小、并发症少,疗效确切,手术安全、有效。Objective To discuss the efficacy of robotic-assisted laparoscopic hemi-nephrectomy for the treatment of complete duplex kidney.Methods We retrospectively reviewed the clinical data of the 20 patients who had robotic-assisted laparoscopic hemi-nephrectomy surgery from March 2017 to November 2019.Four of these patients were male,while the others were female.The average age of these patients was 28.6 months,ranged from 1-2 months.The duplex kidneys were on the upper pole,9 on the left side,and l1 on the right side.All the patients had a history of gradual exacerbations of hydronephrosis before surgery.The most commonly seen symptoms were lumbar/abdominal pain(2 cases),dysuresia(1 case)and leakage of urine(1 case).Twelve patients had a history of repeated urinary tract infections.One patient expressed the cystic mass of the urethra protruded from the external orifice.Preoperative diagnosis was confirmed by magnetic resonance urinary water imaging(MRU),diuretic renal dynamic imaging(ECT),intravenous pyelography(IVP),and voiding cystoureterography(VCUG).Two cases were of ectopic urete,4 of ureterocele and 4 of vesieoureteral reflux(VUR).All the patients underwent hemi-nephrectomy for the treatment of complete duplex kidney.Then we observed the intraoperative and postoperative complications and follow-ups.Results A11 the cases performed by robotic-assisted laparoscopic surgery transperitoneally were completed successfully.There was no significant complication during the surgery with quick recovery after the surgery.The mean operative time was 109.5min(range 82-150 min).The mean estimated blood loss was about 9 ml(range 5-22 ml).Routinely placing a peripelvic catheter drainage was recommended.The mean hospital stay was 5.9 days(range 4-8 days).One patient was lost to follow-up.Mean follow-up was 13.6 months(range 3-30 months).The results of the re-examination of ECT did not indicate loss or atrophy of lower renal function 3 months after operation.Primary symptoms improved.Conclusions Robotic-assisted laparoscopic hemi-n

关 键 词：泌尿生殖系统畸形 重复肾 机器人辅助腹腔镜手术 半肾切除术 儿童 

分 类 号：R726.9[医药卫生—儿科]