机器人辅助腹腔镜手术在儿童重复肾半肾切除术中的疗效分析  

Analysis of Da Vinci robot-assisted laparoscopy in children’s duplication of kidney

作　　者：李泸平[1] 张俊杰[1] 李骥[1] 张胜利[1] 田广超 范应中[1] Li Luping;Zhang Junjie;Li Ji;Zhang Shengli;Tian Guangchao;Fan Yingzhong(Department of Pediatric Surgery,the First Affiliated Hospital of 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：《中华泌尿外科杂志》2021年第5期361-364,共4页Chinese Journal of Urology

摘　　要：目的探讨机器人辅助腹腔镜手术在儿童重复肾半肾切除术中的疗效。方法回顾性分析2017年1月至2019年12月郑州大学第一附属医院54例行重复肾半肾切除术患儿的临床资料,其中42例行腹腔镜重复肾半肾切除术(LH),为LH组;12例行机器人辅助腹腔镜重复肾半肾切除术(RALH),为RALH组。LH组男17例,女25例;年龄(71.74±34.57)个月;左侧29例,右侧13例;临床表现为泌尿系感染19例,排尿间歇漏尿7例,输尿管反流5例,输尿管末端囊肿6例。RALH组男4例,女8例;年龄(76.83±37.33)个月;左侧9例,右侧3例;临床表现为泌尿系感染3例,排尿间歇漏尿2例,输尿管反流1例,输尿管末端囊肿1例。两组患儿年龄、性别、畸形侧别及临床表现的差异均无统计学意义(P>0.05)。两组患儿均行影像学检查,均明确诊断为完全重复肾重复输尿管畸形,且伴有上位输尿管不同程度扩张,上位肾功能明显减退。比较两组手术时间、术中出血量、术后引流时间、住院时间、术后并发症等临床指标。结果LH、RALH组手术时间[(196.48±21.92)min与(171.50±24.91)min]、术中出血量[(34.14±8.63)ml与(18.50±5.92)ml]、术后引流时间[6.0(5.0,7.0)d与4.5(3.0,6.5)d]、术后住院时间[(8.93±1.70)d与(7.33±1.37)d]差异均有统计学意义(P<0.05)。术后随访3个月至2年,两组患儿下位肾均发育良好,术前合并的泌尿系感染、排尿间歇漏尿、排尿困难等症状均在术后逐步缓解、消失。LH组2例术后并发输尿管残端积液、囊肿形成,且反复发作输尿管残端感染,再次手术切除残端后治愈。RALH组无输尿管残端积液及囊肿形成病例。结论儿童RALH术中出血量较少,术后引流时间及住院时间较短,术后并发症发生率较低,疗效及安全性较好。Objective To investigate the efficacy of robot-assisted laparoscopic surgery in heminephrectomy in children.Methods The clinical data of 54 children with heminephrectomy in the First Affiliated Hospital of Zhengzhou University from January 2017 to December 2019 was analyzed retrospectively,of which 42 cases underwent laparoscopic heminephrectomy(LH group)and 12 cases underwent robot-assisted laparoscopic heminephrectomy(RALH group).In LH group,there were 17 males and 25 females,with an average age of(71.74±34.57)months,29 on the left and 13 on the right.In RALH group,there were 4 males and 8 females,with an average age of(76.83±37.33)months,9 on the left and 3 on the right.There was no significant difference in age,sex composition and deformity side between the two groups(P>0.05).The clinical indexes such as operation time,intraoperative blood loss,postoperative drainage time,hospital stay and postoperative complications were compared between the two groups.Results There were significant differences in operation time[(196.48±21.92)min vs.(171.50±24.91)min],intraoperative blood loss[(34.14±8.63)ml vs.(18.50±5.92)ml],postoperative drainage time[6.0(5.0,7.0)d vs.4.5(3.0,6.5)d]and postoperative hospital stay[(8.93±1.70)d vs.(7.33±1.37)d]between LH and RALH groups(P<0.05).During the follow-up from 3 months to 2 years,the lower kidneys of the two groups developed well and the symptoms before operation such as urinary tract infection,intermittent voiding leakage and dysuria caused by ureterocele were gradually relieved and disappeared after operation.In the LH group,2 cases were complicated with the symptoms as ureteral stump effusion,cyst formation and recurrent ureteral stump infection after operation,which were cured after reoperation.There was no case of ureteral stump effusion and cyst formation in the RALH group.Conclusions Robot-assisted laparoscopic heminephrectomy in children has shorter intraoperative blood loss,postoperative drainage time and hospital stay,lower incidence of postoperative complication

关 键 词：泌尿生殖系统畸形 重复肾 机器人 儿童 腹腔镜 

分 类 号：R726.9[医药卫生—儿科]