机器人辅助腹腔镜经结肠系膜途径和经结肠旁沟途径离断式肾盂成形术治疗儿童肾积水的对比研究  

Comparative observation of laparoscopic robot-assisted pyeloplasty through transmesenteric approach and retrocolic approach in the treatment of children with hydronephrosis

作　　者：胡清烜 李爽 杨春雷 徐浩伦 雷伟 肖和 游嘉 王军 程银涛 李刚 Hu Qingxuan;Li Shuang;Yang Chunlei;Xu Haolun;Lei Wei;Xiao He;You Jia;Wang Jun;Cheng Yintao;Li Gang(Department of Urology,Wuhan Children’s Hospital,Wuhan 430019,China)

机构地区：[1]武汉儿童医院泌尿外科,武汉430019

出　　处：《中华泌尿外科杂志》2021年第12期896-900,共5页Chinese Journal of Urology

摘　　要：目的对比研究机器人辅助腹腔镜经结肠系膜途径和经结肠旁沟途径离断式肾盂成形术治疗儿童肾积水的优劣。方法回顾性分析2020年10月至2021年3月武汉儿童医院收治的19例肾积水手术患儿的病例资料,男15例,女4例。平均年龄3.5(0.2~16.8)岁。平均体重18.4(5.5~67.0)kg。2例有腰痛症状,17例为产前检查或体检时发现的无症状患儿。19例患儿中,单纯肾盂输尿管连接处梗阻(UPJO)15例,UPJO合并高位输尿管2例,UPJO合并肾盂输尿管连接处息肉1例,UPJO合并迷走血管压迫输尿管起始部1例。术前行肾盂造瘘3例。肾积水类型为肾外型10例和肾内型9例。患侧肾盂最大前后径平均为2.9(1.2~5.1)cm。术前平均患肾分肾血流灌注比35.4%(23.0%~49.8%)。19例均行机器人辅助腹腔镜离断式肾盂输尿管成形术,手术入路包括经结肠系膜途径11例(系膜组)和经结肠旁沟途径8例(旁沟组)。肾外型10例中,系膜组6例,旁沟组4例;肾内型9例中,系膜组5例,旁沟组4例。不同手术入路分组的年龄、体重、术前患侧分肾功能差异均无统计学意义(P>0.05)。系膜组切开结肠系膜进入腹膜后间隙暴露肾盂,旁沟组切开结肠旁沟处腹膜进入腹膜后间隙暴露肾盂。肾盂和输尿管的切开、裁剪、置管、缝合等步骤两组相同。比较不同手术入路组的手术时间、术中吻合时间、术中出血量、术后住院时间,以及随访情况。结果本研究19例手术均顺利完成,均无中转开放手术者。肾外型患儿中,系膜组和旁沟组的手术时间分别为(108.8±15.5)min和(132.8±7.6)min,术中吻合时间分别为(40.7±6.1)min和(51.5±5.5)min,术中估计出血量分别为(9.5±2.1)ml和(9.3±0.8)ml,术后住院时间分别为(9.0±1.6)d和(9.3±2.9)d,两组的手术时间和术中吻合时间差异有统计学意义(P<0.05)。肾内型患儿中,系膜组和旁沟组的手术时间分别为(136.6±7.9)min和(116.5±13.5)min,术中吻合时间分别为Objective To compare the advantages and disadvantages of laparoscopic robot-assisted transmesenteric approach and retrocolic approach disconnected pyeloplasty in the treatment of children with hydronephrosis.Methods From October 2020 to March 2021,19 children with hydronephrosis were divided into two groups:intra-renal type and extra-renal type.Among them,15 were males and 4 were females.The average age of the patients was 3.5 years old(0.2 years old to 16.8 years old),and the average weight was 18.4 kg(5.5 kg to 67.0 kg).The average ERPF of affected kidney before surgery was 35.4%(23.0%-49.8%).All of them were treated with laparoscopic robot-assisted transmesenteric approach and retrocolic approach disconnected pyeloplasty.The operation was performed in accordance with the standard surgical procedures of the guidelines.After the insertion of the trocar,the children in the transmesenteric group were exposed to the renal pelvis by incising the colonic mesangium into the retroperitoneal space,while in the retrocolic group,the peritoneum was cut into the retroperitoneal space to expose the renal pelvis.After that,the steps of incision,cutting,tube placement,and suture of the renal pelvis and ureter were the same in the two groups.Among the 10 cases of the extrarenal type,6 cases were in the transmesenteric group and 4 cases were in the retrocolic group;among the 9 cases of the intrarenal type,5 cases were in the transmesenteric group and 4 were in the retrocolic group.There was no statistically significant difference in age,weight,and renal function of the affected side before operation in different surgical approach groups(P>0.05).The operation time,intraoperative anastomosis time,intraoperative blood loss and postoperative hospital stay were recorded and compared.There was no statistical difference in the age,weight,and renal function of the affected side before the operation.Results 19 cases were followed up for 6 months,no complications such as fever or wound infection occurred.The operation was successfully com

关 键 词：肾盂积水 手术机器人 肾盂输尿管连接部梗阻 儿童 结肠系膜入路 结肠旁沟入路 

分 类 号：R726.9[医药卫生—儿科]