腹腔镜肾盂离断成形术治疗婴儿重度肾积水  

Laparoscopic Pyeloplasty for Severe Hydronephrosis in Infants

作　　者：高栩 胡岩[1] Gao Xu;Hu Yan(Department of Urology,Children’s Hospital of Hebei Province,Shijiazhuang 050031,China)

机构地区：[1]河北省儿童医院泌尿外科,石家庄050031

出　　处：《中国微创外科杂志》2021年第10期884-888,共5页Chinese Journal of Minimally Invasive Surgery

基　　金：河北省医学科学研究重点课题计划(20200643)。

摘　　要：目的探讨腹腔镜肾盂离断成形术治疗肾盂输尿管连接部梗阻(ureteropelvic junction obstruction,UPJO)所致婴儿重度肾积水的临床效果。方法2017年1月~2019年10月我们采用腹腔镜肾盂离断成形术治疗18例婴儿UPJO。全麻下健侧卧位(左肾积水45°,右肾积水75°),打开结肠系膜或侧腹膜,离断肾盂输尿管连接部,裁剪肾盂,纵行剪开输尿管并与肾盂下极吻合。术中14例留置输尿管双J管引流,4例经肾盏造瘘留置吻合口支架管及肾造瘘管引流。结果18例手术均顺利完成,手术时间120~150 min,平均135 min。术中出血量5~20 ml,平均10 ml。18例术后随访3~15个月,平均3.7月,16例术后3个月肾盂前后径为(8.32±1.44)mm、肾皮质厚度为(7.68±1.84)mm,与术前肾盂前后径(73.26±12.91)mm和肾皮质厚度(3.48±1.27)mm比较,差异均有统计学意义(t=19.180,P=0.000;t=6.887,P=0.000);2例患儿术后初期肾盂前后径仍>3 cm,随诊观察肾积水,分别于4、15个月明显缓解(肾盂前后径<1 cm),无再次外科干预。结论腹腔镜肾盂离断成形术治疗婴儿重度肾积水可行,合理体位下术野清晰、解剖精准,创伤小、恢复快,可有效缓解积水对肾功能及机体的危害。Objective To analyze the clinical effect of laparoscopic pyeloplasty for severe hydronephrosis caused by ureteropelvic junction obstruction(UPJO)in infants.Methods From January 2017 to October 2019,18 infants with UPJO were treated with laparoscopic pyeloplasty.Under general anesthesia,the patients were placed on the healthy lateral position(45°for left hydronephrosis or 75°for right hydronephrosis).The mesocolon or lateral peritoneum was opened,and the ureteropelvic junction was disconnected.The renal pelvis was cut,and the ureter was cut longitudinally and anastomosed with the lower pole of the renal pelvis.During the operation,14 cases were given indwelling ureteral double J tube drainage,and 4 cases were given indwelling anastomotic stent and renal fistula drainage.Results All the 18 cases of operations were successfully completed.The operation time was 120-150 min,with an average of 135 min.The intraoperative blood loss was 5-20 ml,with an average of 10 ml.All the 18 cases were followed up for 3-15 months after operation.The anteroposterior diameter of the renal pelvis and the thickness of the renal cortex were(8.32±1.44)mm and(7.68±1.84)mm in 16 cases at 3 months after operation,which were significantly different from those before operation[(73.26±12.91)mm and(3.48±1.27)mm;t=19.180,P=0.000,t=6.887,P=0.000].The anteroposterior diameter of the renal pelvis was still more than 3 cm in 2 children at early stage after operation,which relieved at 4 and 15 months after operation(anteroposterior diameter of the renal pelvis was less than 1 cm)without reoperation.ConclusionsLaparoscopic pyeloplasty in the treatment of severe hydronephrosis in infants is feasible,with a clear operative field,accurate anatomy,less trauma and quick recovery in an appropriate position.It can effectively alleviate the harm of hydronephrosis to renal function and body.

关 键 词：婴儿 腹腔镜 重度肾积水 肾盂离断成形术 

分 类 号：R69[医药卫生—泌尿科学]