机器人辅助单孔加一孔腹腔镜肾盂成形术在儿童UPJO中的疗效分析  

The research on the efficiency of single-port plus-one robot-assisted pyeloplasty for children with UPJO

作　　者：徐新茹 陈江龙 林珊[1] 何玉峰 徐迪[1] Xu Xinru;Chen Jianglong;Lin Shan;He Yufeng;Xu Di(Department of Pediatric Surgery,Fujian Provincial Hospital,Fuzhou 350001,China;Fujian Medical University,Fuzhou 350001,China)

机构地区：[1]福建省立医院小儿外科,福州350001 [2]福建医科大学,福州350001

出　　处：《中华泌尿外科杂志》2023年第7期524-528,共5页Chinese Journal of Urology

基　　金：小儿外科(省级临床重点专科)项目(2023005)。

摘　　要：目的探讨达芬奇机器人辅助单孔加一孔腹腔镜肾盂成形术在儿童肾盂输尿管连接处梗阻(UPJO)中的疗效。方法回顾性分析2021年9月至2022年8月福建省立医院诊断为UPJO并行机器人辅助单孔加一孔腹腔镜肾盂成形术的13例儿童患者的临床资料。患儿年龄为60.0(1.3,108.0)个月;左侧10例,右侧3例。临床表现为腹痛3例,合并泌尿系感染2例,无症状10例。术前同位素肾图提示患肾功能(28.32±1.82)%,双侧分肾功能相差>10%者7例;机械性梗阻5例;术前超声检查提示患侧肾皮质厚度为(1.98±0.23)cm。术中于脐置入单孔多通道套管并置入机器人系统,于脐上6 cm处置入8 mm套管为加一孔;探查腹膜下扩张的肾盂,经腹壁悬吊牵引肾盂,暴露视野,切开、扩张肾盂,裁剪扩张的肾盂,置入输尿管支架,并吻合肾盂输尿管。结果13例手术均顺利完成,无中转开放手术。手术时间180.0(165.0,190.2)min;术中出血量<5 ml;术后住院时间7.0(7.0,7.0)d,住院费用5.63(5.21,5.65)万元。术后2个月拔除输尿管支架,未出现尿路感染及腰痛等明显并发症。术后随访时间6~18个月,中位值12(8,13)个月。复查泌尿系超声提示肾皮质厚度(4.95±0.57)cm,同位素肾图提示分肾功能(38.02±1.76)%,5例机械性梗阻全部转变为不全性梗阻。结论达芬奇机器人辅助单孔加一孔腹腔镜肾盂成形术手术操作较为精细,在更好的伤口愈合及美容效果基础上,患肾功能得到恢复,并发症少。Objective To investigate the effect of Da Vinci robot-assisted single-port plus-one laparoscopic pyeloplasty(RSPY)in children with ureteropelvic junction obstruction(UPJO).Methods The clinical data of 13 children with UPJO diagnosed by robot-assisted single-port plus-one laparoscopic pyeloplasty in Fujian Provincial Hospital from September 2021 to August 2022 were retrospectively analyzed.The mean age of the children was 60.0(1.3,108.0)months.The lesions of 10 patients were on the left,and 3 were on the right.The clinical manifestations were abdominal pain in 3 cases,urinary tract infection in 2 cases,and no symptoms in 10 cases.Preoperative isotope renogram showed affected renal function(28.32±1.82)%,and bilateral renal function difference>10%in 7 cases.Mechanical obstruction existed in 5 cases.Preoperative ultrasound showed the affected side's renal cortex thickness of(1.98±0.23)cm.During the operation,a single-port multi-channel trocar was placed in the umbilicus with another single port in the epigastrium,and a robotic system was placed to explore the subperitoneal dilated renal pelvis.The renal pelvis was suspended and pulled through the abdominal wall.The visual field was exposed,and the dilated renal pelvis was incised.The dilated renal pelvis was cut,a ureteral stent was placed,and the ureteropelvic duct was anastomosed.Results The operation of 13 cases was successfully completed,without conversion to open surgery.The operation time was 180.0(165.0,190.2)min.The intraoperative blood loss was<5 ml.The postoperative hospital stay was 7.0(7.0,7.0)d,and hospitalization costs were 56.3(52.1,56.5)thousand yuan.The ureteral stent was removed 2 months after the operation,and no obvious complications such as urinary tract infection or low back pain occurred.The median postoperative follow-up was 12 months,ranged from 6 to 18 months.Urinary color ultrasound showed that the renal cortex was(4.95±0.57)cm,which was thicker than before.Isotope renogram showed that the renal function was(38.02±1.76)%,which was highe

关 键 词：儿童 肾盂成形术 机器人手术 单孔加一孔 肾积水 

分 类 号：R726.9[医药卫生—儿科]