机器人辅助腹腔镜小儿肾盂输尿管离断成形术16例  

Robot-assisted Laparoscopic Pyeloplasty in 16 Children

作　　者：林扬 徐迪[1] 林珊[1] 李立帜[1] Lin Yang;Xu Di;Lin Shan(Department of Pediatric Surgery,Provincial Clinical Medical College of Fujian Medical University,Fujian Provincial Hospital,Fuzhou 350001,China)

机构地区：[1]福建医科大学省立临床医学院福建省立医院小儿外科,福州350001

出　　处：《中国微创外科杂志》2022年第7期536-539,共4页Chinese Journal of Minimally Invasive Surgery

基　　金：福建省卫计委医学创新课题(2020CXB004);福建省自然科学基金(2021J01121777)。

摘　　要：目的探讨机器人辅助腹腔镜肾盂成形术(robot-assisted laparoscopic pyeloplasty,RALP)治疗小儿肾盂输尿管连接部梗阻(ureteropelvic junction obstruction,UPJO)的临床效果。方法2020年10月~2021年12月我科行RALP治疗16例小儿UPJO。建立机械臂,进腹腔后经肠系膜入路,确定病变部位,裁剪扩张的肾盂,切除狭窄段输尿管,缝合吻合口,缝合切口。结果16例RALP均顺利完成,无中转开放手术。手术时间110~235 min,平均160 min,其中输尿管肾吻合时间40~55 min,平均50 min。术中出血量<10 ml。术后住院时间4~8 d,平均5.5 d。住院费用48391~58622元,平均53839元。术后1个月拔除双J管。1例术后4周出现尿路感染,口服头孢克洛抗炎3 d后治愈。16例随访2~12个月,中位随访时间9个月,12例术后6个月肾皮质厚度与术前比较明显增加[(4.94±0.58)mm vs.(1.97±0.27)mm,t=22.293,P=0.000],同位素肾图提示分肾功能恢复良好[(38.03±1.76)%vs.(28.32±1.82)%,t=49.396,P=0.000]。结论RALP治疗小儿UPJO效果良好。Objective To explore the clinical outcomes of robot-assisted laparoscopic pyeloplasty(RALP).Methods Clinical data of 16 children with ureteropelvic junction obstruction(UPJO)who underwent the da Vinci RALP from October 2020 to December 2021 were retrospectively analyzed.The robotic arms were established.After entering the abdominal cavity,the mesenteric approach was applied.The lesion location was determined and the expanded renal pelvis was tailored and the narrow segment ureter was removed.The anastomosis was performed and the incision was sutured.Results The RALP procedure was successfully completed in all the 16 patients without conversion to open surgery.The mean operating time was 160 min(range,110-235 min),the mean ureter-renal anastomosis time was 50 min(range,40-55 min),and the intraoperative blood loss was less than 10 ml.The duration of postoperative hospitalization was 4-8 d,with a mean of 5.5 d.The mean cost of hospitalization was 53839 yuan(range,48391-58622 yuan).The double-J stent was extracted in outpatient clinic 1 month later.Urinary infection was observed in 1 case at 4 weeks after surgery,and symptoms were resolved after oral cefaclor medication for 3 d.All the 16 cases were followed up for 2-12 months,with a median of 9 months.The thickness of renal cortex in 12 cases increased significantly 6 months after operation[(4.94±0.58)mm vs.(1.97±0.27)mm,t=22.293,P=0.000].The isotope renogram showed that the recovery of renal function was good[(38.03±1.76)%vs.(28.32±1.82)%,t=49.396,P=0.000].Conclusion RALP is effective in the treatment of UPJO in children.

关 键 词：肾积水 腹腔镜 机器人 肾盂成形术 小儿 

分 类 号：R726.9[医药卫生—儿科]