腹腔镜输尿管端侧吻合联合膀胱再植术治疗儿童复杂重复肾畸形  

Laparoscopic end-to-side ureterostomyplus ureterovesical replantation for complex duplication of kidney in children

作　　者：崔展阁 张谦[1] 李骥[1] 郭立华[1] 王磊[1] 孙权[1] 傅淑琪 Cui Zhange;Zhang Qian;Li Ji;Guo Lihua;Wang Lei;Sun Quan;Fu Shuqi(Department of Pediatric Surgery,First Affiliated Hospital,Zhengzhou University,Zhengzhou 450052,China)

机构地区：[1]郑州大学第一附属医院小儿外科,郑州450052

出　　处：《中华小儿外科杂志》2023年第5期416-421,共6页Chinese Journal of Pediatric Surgery

摘　　要：目的探讨采用腹腔镜下输尿管端侧吻合联合输尿管膀胱再植术治疗儿童复杂重复肾畸形的效果及预后情况。方法收集郑州大学第一附属医院2020年6月至2022年6月手术治疗重复肾患儿的临床资料,选取同侧双输尿管病变的复杂重复肾畸形的病例患儿11例,其中男1例,女10例;平均月龄为33.5个月,范围为3~73个月;重复肾左侧7例,右侧2例,双侧2例。术前完善泌尿系B型超声、泌尿系CT血管造影/CT尿路造影、肾动态核素显像、磁共振泌尿系水成像、排泄性膀胱尿路X线造影等影像学检查,采用腹腔镜下输尿管端侧吻合联合输尿管膀胱再植术治疗。分析手术时长、出血量、术后住院天数、术前术后肾盂前后径变化、输尿管管径粗细、肾实质厚度、患肾部分肾功能、术后并发症等指标。数据采用配对t检验。结果11例患儿中上位输尿管末端囊肿5例,上位输尿管末端梗阻6例(含输尿管开口异位3例),下位肾积水伴输尿管反流8例,下位肾积水伴输尿管末端梗阻3例。所有患儿均顺利行腹腔镜下输尿管端侧吻合联合输尿管膀胱再植术,手术时长为(242.22±93.15)min,均未中转开放,术中出血0~20 ml,均未输血,术后住院天数(11.20±2.60)d。术后上位肾盂前后径为(8.17±3.96)mm,术后上位肾输尿管管径为(6.83±3.56)mm,术后下位肾盂前后径为(11.08±9.29)mm,术后下位肾输尿管管径为(5.14±2.63)mm,相较于术前,术后各指标差异具有统计学意义(P<0.05)。术后肾实质厚度为(8.51±3.20)mm,术后患肾部分肾功能为(40.62±13.52)%,与术前肾实质厚度、患肾部分肾功能相比,差异具有统计学意义(P<0.05)。所有患儿随访6~24个月,术后排尿异常症状完全消失,尿路感染无复发;出现并发症1例,术后3个月复查提示下位肾积水进行性加重,患肾部分肾功能较前下降,之后行腹腔镜下左侧重复肾切除术,术后病理结果提示肾实质萎缩,实质内肾小�Objective To explore the curative efficacy and prognosis of laparoscopic end-to-side ureterostomy plus ureterovesical replantation for complicated recurrent renal malformation in children.Methods From June 2020 to June 2022,11 children with complex renal duplication with ipsilateral bilateral ureteral lesions were recruited.There were 1 boy and 10 girls with an average age of 33.5(3-73)months.Duplicate kidney was located at left side(n=7),right side(n=2)and bilaterally(n=2).Prior to operation,ultrasonography of urinary system,computed tomography(CT)angiography/urography of urinary system,dynamic renal radionuclide imaging,magnetic resonance hydrographic imaging of urinary system,excretory bladder urography and other imaging examinations were completed.Laparoscopic end-side ureteral anastomosis plus ureteral bladder replantation were performed.The changes of operative duration,volume of blood loss,postoperative hospitalization time,anteroposterior diameter of renal pelvis,diameter of ureter,thickness of renal parenchyma,partial renal function and postoperative complications were recorded.Results Among them,there were upper ureteral terminal cyst(n=5),upper ureteral terminal obstruction(n=6,including 3 cases of ectopic ureteral opening),lower hydronephrosis with ureteral reflux(n=8)and lower hydronephrosis with ureteral terminal obstruction(n=3).Laparoscopic ureteral end-side anastomosis plus ureteral bladder replantation were performed without any conversion into open surgery or blood transfusion.Operative duration was(242.22±93.15)min,intraoperative blood loss(0-20)ml and postoperative hospitalization stay(11.2±2.6)day.Anteroposterior diameter of upper renal pelvis was(8.17±3.96)mm,postoperative diameter of upper renal ureter(6.83±3.56)mm,postoperative anteroposterior diameter of lower renal pelvis(11.08±9.29)mm and postoperative diameter of lower renal ureter(5.14±2.63)mm.Significant differences existed in all postoperatively parameters(P<0.05).Thickness of renal parenchyma post-operation was(8.51±3.20)mm

关 键 词：肾 畸形 腹腔镜 输尿管再植术 儿童 

分 类 号：R726.9[医药卫生—儿科]