运用腹腔镜修复肾盂成形术后再梗阻患儿的难点及原因分析  

Laparoscopic difficulties and causes of an initial failure of surgical pyeloplastyin in children

作　　者：李骥[1] 张谦[1] 郭立华[1] 王磊[1] 孙权[1] 刘艳飞 刘宁[1] 王冰蕊 Li Ji;Zhang Qian;Guo Lihua;Wang Lei;Sun Quan;Liu Yanfei;Liu Ning;Wang Bingrui(Department of Pediatric Surgery,First Affiliated Hospital,Zhengzhou University,Zhengzhou 450052,China)

机构地区：[1]郑州大学第一附属医院小儿外科,450052

出　　处：《中华小儿外科杂志》2021年第1期53-57,共5页Chinese Journal of Pediatric Surgery

摘　　要：目的探讨运用腹腔镜治疗肾盂成形术后再次梗阻患儿的可行性。方法收集郑州大学第一附属医院小儿外科2018年2月至2019年7月收治的6例肾盂成形术后再次梗阻患儿的相关资料。其中,男4例,女2例;平均年龄为4岁2个月;患侧为右侧4例,左侧2例;首次手术4例为开放肾盂成形术,2例为腹腔镜肾盂成形术;术后彩色多普勒超声检查均提示肾盂前后径较术前无缓解,均>30 mm,术后患儿出现腹疼、泌尿道感染等症状,均采用腹腔镜进行修复,再次行肾盂成形术,留置输尿管支架管和导尿管。结果所有患儿手术过程顺利,术中病理学检查提示肾盂输尿管高位吻合1例,吻合口瘢痕致梗阻2例,吻合迂曲折叠致粘连梗阻1例,异位血管压迫1例,局部止血纱布未完全吸收导致压迫性梗阻1例,手术时间范围为140~220 min,平均165 min,无中转开放手术,无输血,无肠管或阑尾代输尿管,导尿管于术后7~10 d拔出,输尿管支架管于术后6~8周拔除。术后随访满意,所有患儿的肾积水程度均得到有效缓解率。结论运用腹腔镜治疗肾盂成形术后的再次梗阻是可行的。Objective To summarize the causes of reobstruction after an initial pyeloplasty and explore the feasibility of laparoscopic treatment.Methods From February 2018 to July 2019,6 cases of reobstruction after an initial laparoscopic pyeloplasty were reviewed.There were 4 boys and 2 girls with an average age of 50 months.The involved side was right(n=4)and left(n=2).Open(n=4)and laparoscopic(n=2)pyeloplasty was performed.The anteroposterior diameters of renal pelvis were over 30 mm.Children with abdominal pain or urinary tract infection underwent laparoscopic pyeloplasty plus insertions of ureteral stent and catheter.Results All children recovered smoothly.Intraoperative pathology showed anastomosis not at the lowest of pelvis and ureter(n=1),local scar in ureteropelvic junction(n=2),partial circuity at the junction of pelvis and ureter(n=1),ectopic vascular compression missed initially(n=1)and compression of absorbable hemostatic gauze(n=1).The average operative duration was 165(140-220)min.There was no conversion into open surgery,no blood transfusion or no replacement of intestine or appendix for ureter.The catheters were removed at Days 7-10 postoperatively and ureteral stent at Weeks 6-8.All postoperative follow-ups were satisfactory and hydronephrosis became relieved in all cases.Conclusions Laparoscopy is feasible for reobstruction after an initial pyeloplasty.

关 键 词：腹腔镜 肾盂成形术 再次手术 

分 类 号：R726.9[医药卫生—儿科]