达芬奇机器人辅助手术治疗儿童双侧肾盂输尿管连接部狭窄  

Robotic-assisted bilateral simultaneous dismembered pyeloplasties in children

作　　者：谢钧韬[1] 高文宗[1] 李作青[1] 周李[1] 徐哲[1] Xie Juntao;Gao Wenzong;Li Zuoqing;Zhou Li;Xu Zhe(Department of Pediatric Surgery,First Affiliated Hospital,Sun Yat-sen University,Guangzhou 510080,China)

机构地区：[1]中山大学附属第一医院小儿外科,广东省广州市510080

出　　处：《临床小儿外科杂志》2021年第3期257-262,共6页Journal of Clinical Pediatric Surgery

基　　金：广东省科技计划(编号:2012B031800297)。

摘　　要：目的初步总结达芬奇机器人辅助手术治疗儿童双侧肾盂输尿管交界部狭窄的经验,探讨达芬奇机器人手术同时治疗双侧肾盂输尿管交界部的安全性和有效性。方法回顾性分析中山大学附属第一医院小儿外科2016年1月至2019年11月采用达芬奇机器人辅助手术治疗的7例双侧肾盂输尿管交界部狭窄患者临床资料。7例均为男性,年龄4岁6个月至16岁,平均年龄8岁6个月。3例产前检查发现双肾积水,随诊过程中发现双肾积水进行性加重。3例因腹痛或腰痛就诊,检查发现双肾重度积水;1例因体检发现双肾重度积水。肾积水均为SFUⅢ级~Ⅳ级,术前影像学检查(B超、核素肾图、CT或者MR)均提示双侧UPJO,均行达芬奇机器人辅助下双侧同时离断式肾盂输尿管吻合术。结果7例均顺利完成手术,无一例中转开放手术,手术时间147~204 min,平均177 min。术中出血2~20 mL,平均8.8 mL。所有患者顺利出院,术后外观满意。随访3个月至4年1个月,平均1年3个月。拔除双J管后定期复查泌尿系统B超,其中1例术后出现反复泌尿系统感染,经排尿性膀胱尿道造影提示双侧膀胱输尿管Ⅲ度反流,行双侧输尿管膀胱再植术后复查B超提示恢复良好。所有患者术后症状消失,随访至今,14侧肾积水中5侧积水完全消失,9侧积水缓解。结论达芬奇机器人辅助双侧同时肾盂输尿管吻合术安全、有效,术后外观满意。Objective To summarize our institutional experiences of robotic-assisted laparoscopic(RAL)simultaneous treatment of bilateral ureteropelvic junction obstruction(UPJO)and evaluate its safety and feasibility.Methods A retrospective review was performed for 7 bilateral UPJO boys undergoing simultaneous bilateral robotic-assisted dismembering laparoscopic pyeloplasty between January 2016 and November 2019.The average age was 102(54-192)months.Three cases were prenatally diagnosed as bilateral hydronephrosis and hydronephrosis worsened during follow-ups.Another three children had a chief complain of flank pain and bilateral hydronephrosis was detected promptly.One case of severe bilateral hydronephrosis was diagnosed during a routine examination.Bilateral UPJO with SFU grade Ⅲ to Ⅳ hydronephrosis was confirmed preoperatively by ultrasound,nephrogram,computed tomography(CT)and magnetic resonance imaging(MRI).Results There was no need of open conversion.The mean operative duration was 177(147-204)min and the mean estimated volume of blood loss 8.8(2-20)ml.All children recovered well and were discharged with excellent cosmetic outcomes.The mean follow-up period was 15(3-49)months.After removal of ureteral stents,one of the children occured recurrence urinary infection,then bilateral Ⅲ grade of vesicoureteral reflux were found under a voiding cystourethrography,bilateral Cohen surgery were taken for this child soon after and he had no more urinary infection after that.All children's symptoms have disappeared,hydronephrosis of five renal units were resolved and nine renal units were improved.Conclusion With excellent cosmetic outcomes,robotic-assisted bilateral concurrent dismembering pyeloplasty is both safe and effective for bilateral UPJO.

关 键 词：肾盂输尿管连接处狭窄/外科学 肾积水/外科学 腹腔镜检查 机器人 

分 类 号：R726.9[医药卫生—儿科] R692.2[医药卫生—临床医学]