机器人辅助腹腔镜技术治疗儿童重复肾合并肾盂输尿管连接部梗阻  

Application of robot-assisted laparoscopy for duplex kidneys with ureteropelvic junction obstruction in children

作　　者：周立军 谢华[1] 陈方[1] 黄轶晨[1] 吕逸清[1] 陈艳[1] Zhou Lijun;Xie Hua;Chen Fang;Huang Yichen;Lyu Yiqing;Chen Yan(Department of Urology,Affiliated Children's Hospital,Shanghai Jiao Tong University,Shanghai 200062,China)

机构地区：[1]上海市儿童医院,上海交通大学附属儿童医院泌尿外科,200062

出　　处：《中华小儿外科杂志》2021年第10期907-910,共4页Chinese Journal of Pediatric Surgery

基　　金：上海市市级医院新兴前沿技术联合攻关项目(SHDC12010108)。

摘　　要：目的探讨机器人辅助腹腔镜技术在儿童重复肾合并上下肾肾盂输尿管连接部梗阻(ureteropelvic junction obstruction,UPJO)治疗中的应用。方法收集2015年1月至2017年12月上海交通大学附属儿童医院泌尿外科收治的4例运用机器人辅助腹腔镜技术治疗的重复肾合并上下肾UPJO患儿的相关资料。其中,男3例,女1例;平均年龄为4岁4个月,年龄范围为3岁8个月至5岁1个月;均为因腹痛就诊检查发现肾积水,既往无泌尿系感染史,病变均为左侧。术前均完善B型超声、磁共振尿路成像和(或)增强CT、排尿期膀胱尿道造影、同位素肾图检查,未见膀胱输尿管反流。除1例在术前经上述检查未提示存在明确的重复肾征象,其他3例经上述检查后考虑诊断为重复肾;3例患儿于术前行逆行输尿管造影检查(1例为完全性重复肾,2例为不完全性重复肾),1例术前未行逆行输尿管造影检查。术前同位素肾图检查均提示患侧分肾功能明显受损,告知家长病情后,要求保留受累半肾,行机器人辅助腹腔镜手术。均运用机器人辅助腹腔镜技术,采用经典离断式肾盂成形术,未增加辅助孔。结果术中发现上肾UPJO 1例,为完全性重复肾;下肾UPJO 3例,均为不完全性重复肾,其中1例合并马蹄肾;1例UPJO为扭曲折叠,1例为单纯狭窄,1例为高位输尿管,1例为血管压迫。术中均留置DJ管,腹腔内操作的平均时间为105 min,平均吻合时间为44 min。所有患儿在术中均无中转开放,术后平均住院时间为4.5 d。术后6~8周拔除DJ管,平均随访时间为36个月,范围为26~60个月,术后肾盂分离程度均较术前降低,患肾分肾功能与术前相比,1例略有改善,3例明显改善。结论应用机器人辅助腹腔镜技术治疗儿童重复肾合并上下肾UPJO是安全、有效的。Objective To explore the value of robot-assisted laparoscopy for duplex kidneys complicated with left upper/lower pole ureteropelvic junction obstruction(UPJO)in children.Methods From January 2015 to December 2017,retrospective analysis was performed for clinical data of 4 children with duplex kidneys complicated with left upper/lower pole UPJO undergoing robot-assisted laparoscopy.There were 3 boys and 1 girl with a mean age of 52(44-61)months.All cases had a complaint of abdominal pain without a previous history of urinary tract infection.Ultrasonography,magnetic resonance urography(MRU)and/or enhanced computed tomography(CT),voiding cystourethrography(VCUG)and dynamic renography pre-operation were performed.None of them revealed VUR(vesicalureteral reflux).Retrograde ureterograghy revealed complete duplicated ureter(n=1)and incomplete duplicated ureter(n=2).Renography hinted at impaired split renal function with parental consent.Dismembered pyeloplasty was performed under robot-assisted laparoscopy without auxiliary Trocar.Results Upper moiety with complete duplicated ureter(n=1)and lower moiety with incomplete duplicated ureter(n=3)were detected along with horseshoe kidney(n=1).All case were indwelled intraoperatively with double-J tube.The mean intra-abdominal operative duration was 105 min and the mean anastomotic duration 44 min;UPJ genre was twisted folding(n=1),stenosis(n=2)and vascular bundle compression(n=1).The postoperative hospitalization stay was 4.5 days.Double-J was removed at 6-8 weeks postoperatively.During a mean follow-up period of 36(26-60)months,APD(anteroposterior diameter)shrank and split renal function improved slightly(n=1)and apparently(n=3).Conclusions Robot-assisted laparoscopy may be safely and effectively applied for pediatric duplex kidneys with upper/lower pole UPJO.

关 键 词：机器人 腹腔镜 儿童 重复肾 肾盂输尿管连接部梗阻 肾盂成形术 

分 类 号：R726.9[医药卫生—儿科]