机器人辅助单孔腹腔镜在小儿泌尿生殖系统手术中的应用  

Clinical application of da Vinci robot-assisted single-port laparoscopy in pediatric genitourinary diseases

作　　者：高贺云 李庚 张文[1] 刘一帆[1] 黄光斌 胡涛 杜国伟 郭云凯 Gao Heyun;Li Geng;Zhang Wen;Liu Yifan;Huang Guangbin;Hu Tao;Du Guowei;Guo Yunkai(Department of Pediatric Surgery,Zhongnan Hospital of Wuhan University,Wuhan 430071,China)

机构地区：[1]武汉大学中南医院小儿外科,武汉430071

出　　处：《中华小儿外科杂志》2023年第7期597-601,共5页Chinese Journal of Pediatric Surgery

摘　　要：目的初步探讨达芬奇Xi机器人系统辅助单孔腹腔镜在小儿泌尿生殖系统手术中应用的可行性及安全性。方法回顾性分析2020年6月至2022年6月在武汉大学中南医院小儿外科施行机器人辅助单孔腹腔镜手术的29例患儿临床资料,其中男13例,女16例;年龄为(5±3.5)岁,范围在1个月至10.5岁。所有患儿中肾盂输尿管连接部梗阻16例,重复肾5例,卵巢畸胎瘤3例,发育不良肾2例,膀胱输尿管反流2例,输尿管膀胱连接部梗阻1例,肾囊肿1例。所有患儿均采用多通道单孔腹腔镜手术穿刺器,经脐单部位完成机器人辅助腹腔镜手术,总结分析其手术时间、术后住院时间、并发症等情况。结果29例机器人辅助单孔腹腔镜手术均顺利完成,无术中中转开放手术。18例行肾盂成形术,4例行输尿管膀胱再植术,1例行输尿管输尿管端侧吻合术,2例行发育不良肾切除,1例行肾囊肿去顶减压术,3例行卵巢肿瘤剔除术;其中15例患儿合并内环口未闭,同时行内环口高位结扎。肾盂成形术、输尿管膀胱再植术和卵巢肿瘤剔除术手术时间分别为(168.5±42.3)min、(152.8±51.7)min、(146.3±32.0)min;术后住院时间分别为(8.3±3.5)d、(7.3±2.6)d、(4.7±2.1)d。肾盂成形术后1例并发尿外漏,充分引流保守9 d后治愈;1例术后2周并发泌尿系感染,口服抗生素治愈。术后随访时间为(18.7±2.5)个月,无其他严重术中术后并发症发生。所有患儿脐部切口隐匿,术后外观满意。结论经脐机器人辅助单孔腹腔镜应用于小儿泌尿生殖系统的治疗安全可行,切口隐匿美观。Objective To primarily explore the feasibility and safety of da Vinci Xi robot-assisted single-port laparoscopy for urogenital system in children.Methods From June 2020 to June 2022,retrospective review was performed for clinical data of 29 children undergoing robot-assisted single-port laparoscopy.There were 13 boys and 16 girls with an average age of(60±42)(1-126)months.There were ureteropyeloureter junction stenosis(n=16),duplicate kidney(n=5),ovarian teratoma(n=3),dysplastic kidney(n=2),vesicoureteral reflux(n=2),ureterovesical junction obstruction(n=1)and renal cyst(n=1).Robot-assisted laparoscopy was performed through a single umbilical site through a multi-channel single port laparoscopic puncture device.Operative duration,postoperative hospital stay and complications were recorded.Results All procedures were successfully completed without any intraoperative conversion into open surgery.The specific procedures were pyeloplasty(n=18),ureteral bladder replantation(n=4),ureteroureterostomy(n=1),dysplastic nephrectomy(n=2),renal cyst decapitation and decompression(n=1)and ovarian tumor excision(n=3).High ligation of internal ring was performed in 15 children with patent internal ring opening.Mean total operative duration of pyeloplasty,ureteral bladder replantation and ovarian tumor excision were(168.5±42.3)min,(152.8±51.7)min and(146.3±32)min and mean postoperative hospital time(8.3±3.5)days,(7.3±2.6)days and(4.7±2.1)days respectively.One case of urinary leakage after pyeloplasty was cured after 9-day conservative drainage.Another case of urinary tract infection at 2 weeks post-pyeloplasty and was cured with oral antibiotics.During a mean follow-up period of(18.7±2.5)months,there were no other serious perioperative complications.All of them had concealed umbilical incision and satisfactory postoperative appearances.Conclusions Transumbilical single-port robot-assisted laparoscopy is both safe and feasible for urinary and reproductive system malformation in children.And the incision is concealed and ae

关 键 词：机器人手术 机器人辅助腹腔镜手术 肾盂输尿管连接部梗阻 卵巢畸胎瘤 

分 类 号：R726.9[医药卫生—儿科]