腹腔镜手术治疗小儿输尿管中段梗阻  

Efficacy of laparoscopy for midureteral obstruction in children

作　　者：高晓峰 刘国昌 伏雯 朱士博 束方鹏 周锐 张锦 贾炜 Gao Xiaofeng;Liu Guochang;Fu Wen;Zhu Shibo;Shu Fangpeng;Zhou Rui;Zhang Jin;Jia Wei(Department of Pediatric Urology,Municipal Women&Children's Medical Center,Guangzhou 510623,China)

机构地区：[1]广州市妇女儿童医疗中心小儿泌尿外科,广州510623

出　　处：《中华小儿外科杂志》2022年第8期739-742,共4页Chinese Journal of Pediatric Surgery

摘　　要：目的探讨腹腔镜输尿管端端吻合术治疗小儿输尿管中段梗阻的疗效,总结诊治经验。方法收集2015年12月至2019年12月间广州市妇女儿童医疗中心收治的8例腹腔镜手术治疗输尿管中段梗阻的临床资料。本组8例患儿,男6例,女2例;中位年龄7.3岁,年龄范围3~15岁;左侧3例,右侧5例;无症状肾积水2例,间歇性腹痛5例,反复尿路感染1例。手术成功定义为解除症状性梗阻或肾积水情况改善。8例患儿均采用经腹腔入路腹腔镜下输尿管端端吻合术,探查并切除病变段输尿管,6-0可吸收线间断缝合输尿管,吻合口呈斜面且保证无张力。结果本组8例患儿腹腔镜手术全部获得成功,无中转开腹,术后痊愈出院。手术中位时间125.8 min,时间范围110~150 min,住院时间9~12 d,平均10.2 d,无输血。术中证实梗阻病因,3例输尿管管腔狭窄,4例腔静脉后输尿管,1例输尿管息肉。8例患儿术后均获得随访,随访时间满1年,术后临床症状消失,肾积水情况明显改善,未见息肉复发。结论先天性输尿管中段梗阻临床少见,腹腔镜输尿管端端吻合术治疗小儿输尿管中段梗阻是安全、有效及微创的方法,具有较好的临床应用价值。Objective To explore the efficacy of laparoscopic end-to-end ureteroureterostomy(UU)for midureteral obstruction in children and to summarize our institutional management experiences.Methods From December 2015 to December 2019,clinical data were retrospectively reviewed for 8 children of midureteral obstruction undergoing laparoscopy.There were 6 boys and 2 girls with a mean age of 7.3(3-15)years.The involved side was left(n=3)and right(n=5).There were asymptomatic hydronephrosis(n=2),intermittent abdominal pain(n=5)and recurrent urinary tract infection(n=1).Successful operation was defined as a relief of symptomatic obstruction or an improvement of hydronephrosis.All of them underwent transperitoneal laparoscopic end-to-end UU.Ureter was sutured intermittently with a 6-0 absorbable thread and anastomosis was inclined for non-tension.Results All of them underwent laparoscopy successfully without any conversion into laparotomy.The mean operative duration was 125.8(110-150)min and the mean length of stay 10.2(9-12)days.No blood transfusion was offered.The causes of obstruction were confirmed intraoperatively as ureteral stenosis(n=3),posterior vena cava ureter(n=4)and ureteral polyp(n=1).During a postoperative follow-up period of over 1 year,clinical symptoms disappeared,hydronephrosis improved markedly and no polyp recurred.All recovered well and were discharged.Conclusion Congenital midureteral obstruction is rare in clinical practices.Laparoscopic end-to-end UU is safe,effective and mini-invasive for midureteral obstruction in children.Clinical applications are promising.

关 键 词：腹腔镜 输尿管梗阻 输尿管端端吻合术 畸形 

分 类 号：R726.5[医药卫生—儿科]