经肾盏或肾盂造瘘外引流的婴儿腹腔镜肾盂成形术  

Laparoscopic Pyeloplasty in Infants With External Drainage via Calyceal or Pyelostomy

作　　者：胡岩[1] 高栩 聂正冬 Hu Yan;Gao Xu;Nie Zhengdong(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》2022年第11期914-917,共4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：目的探讨婴儿腹腔镜肾盂成形术中经肾盏或肾盂造瘘外引流的应用价值。方法2020年1月~2021年12月,10例婴儿腹腔镜肾盂成形术中留置输尿管双J管失败(未能置入膀胱),6例经肾盏造瘘,4例经肾盂造瘘,留置吻合口支架管及外引流管引流。结果6例经肾盏造瘘外引流者手术时间120~135 min,平均132 min,术后2周先后拔除吻合口支架管及外引流管,无漏尿、发热、泌尿系感染;4例经肾盂造瘘外引流者手术时间130~150 min,平均145 min,2例术后2周先后拔除吻合口支架管及外引流管,1例拔管后泌尿系感染,1例吻合口支架管拔除困难延迟至术后4周拔管。10例术后3、6个月随访,B超显示肾盂前后径[(8.1±0.8)mm]较术前[(56.9±11.8)mm]明显缩小(P=0.000),肾皮质厚度[(7.7±1.4)mm]较术前[(3.2±0.9)mm]明显增加(P=0.000)。结论婴儿腹腔镜肾盂成形术中输尿管双J管置入失败时,经肾盏或肾盂造瘘外引流均可顺利完成手术。经肾盏造瘘术野清晰,并发症少,拔管顺利。Objective To evaluate the value of external drainage via calyceal or pyelostomy in laparoscopic pyeloplasty in infants.Methods From January 2020 to December 2021,10 infants underwent laparoscopic pyeloplasty with failure of indwelling double J ureteral tube(failed to insert bladder),including 6 cases of calyceal fistula and 4 cases of pyelostomy.The indwelling anastomotic stent and external drainage tube were placed.Results In 6 patients with external drainage via calyceal,the operation time was 120-135 min(mean,132 min),and the anastomotic stent and external drainage tube were removed two weeks after operation without leakage of urine,fever or urinary infection.In 4 patients with external drainage of pyelostomy,the operation time was 130-150 min(mean,145 min).The anastomotic stent and external drainage tube were removed two weeks after operation in 2 cases.One case had urinary tract infection after extubation,and one case had difficulty in extubation until extubation four weeks after operation.The 10 cases were followed up at postoperative 3 and 6 months.Ultrasound showed renal pelvis size reduced significantly[(8.1±0.8)mm vs.(56.9±11.8)mm,P=0.000],and renal cortical thickness increased significantly[(7.7±1.4)mm vs.(3.2±0.9)mm,P=0.000].Conclusions When double J ureteral tube placement fails in laparoscopic pyeloplasty in infants,the operation can be successfully completed by external drainage through calyces or pyelostomy.Transcalyceal fistula has clear surgical field,few complications and smooth extubation.

关 键 词：婴儿 腹腔镜 肾盂成形术 引流 

分 类 号：R726.9[医药卫生—儿科]