机器人辅助腹腔镜肾盂成形术治疗儿童肾盂成形术后再梗阻的初步经验  

Preliminary experience of robot-assisted laparoscopic pyeloplasty for the treatment of recurrent obstruction in children after pyeloplasty

作　　者：刘德鸿[1] 李品 路腾飞 李博健 陶天 马立飞 周晓光 周辉霞 Liu Dehong;LiPin;Lu Tengfei;Li Bojian;Tao Tian;Ma Lifei;Zhou Xiaoguang;Zhou Huicia(Department of Pediatric Surgery,Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine,Shanghai 200025,China;"Department of Pediatric Urology,the Seventh Medical Center of PLA General Hospital,Beijing 100871,China)

机构地区：[1]上海交通大学医学院附属瑞金医院小儿外科,上海200025 [2]解放军总医院第七医学中心儿童泌尿外科,北京100871

出　　处：《微创泌尿外科杂志》2024年第4期248-251,共4页Journal of Minimally Invasive Urology

基　　金：首都卫生发展专项(2022-2-5083);上海市级医院促进临床专科能力提升项目(SHDC22022306)。

摘　　要：目的:总结机器人辅助腹腔镜肾盂成形术治疗儿童肾盂成形术后再梗阻的初步经验。方法:回顾性分析解放军总医院第七医学中心儿童泌尿外科2019年1月至2023年12月采用机器人辅助腹腔镜肾盂成形术治疗17例肾积水肾盂输成形术后再梗阻患儿,其中男14例,女3例,平均年龄为(6.1±0.6)岁,平均体质量为(18.7±1.8)kg,左侧11例,右侧6例。本研究根据临床和影像学资料对儿童肾盂成形术后再梗阻的诊断和结果进行评估。结果:17例再梗阻患儿手术均获得成功,无术中并发症。平均手术时间(78.5±10.2)min、术中平均出血量(10.0±2.0)ml、平均进食时间(3.0±0.4)h、平均引流管拔除时间(4.1±0.5)d、术后平均住院时间(7.0±1.5)d。所有患者均得到随访,术后随访时间4~24个月,术后ClavienⅠ~Ⅱ级并发症发生率23.5%(4/17),经保守治疗后好转;术后无吻合口狭窄、再次梗阻、泌尿系感染等ClavienⅢ、Ⅳ级并发症。术后3个月复查17例患儿,B超显示肾盂前后径平均值为(1.8±0.3)cm,较术前[(3.5±0.3)cm]减小(P<0.05);同位素排泄性T1/2显示肾盂输尿管无梗阻;分肾功能[(39.7±1.8)%]与术前[(36.2±1.3)%]比较,差异无统计学意义(P>0.05)。结论:机器人辅助腹腔镜肾盂成形术治疗儿童肾盂成形术后再梗阻安全、有效。Objective:To summarize the preliminary experience with robot-assisted laparoscopic pyeloplasty for the treatment of recurrent obstruction after pyeloplasty in children.Methods:A retrospective study was conducted of 17 cases of recurrent obstruction after pyeloplasty in children who underwent robotic-assisted laparoscopic pyeloplasty in the Seventh Medical Center of PLA General Hospital between January 2019 and December 2023.There were 14males and 3 females with a mean age of(6.1±0.6)years,the average weight was(18.7±1.8)kg,11 cases on left and 6 cases on right.The diagnosis and outcomes of recurrent obstruction were reviewed on clinical and imaging data.Results:All operations were successful in the 17 cases of recurrent obstruction with no serious intraoperative complication.The average operative time was(78.5±10.2)min,the average intraoperative blood loss was(10.0±2.0)ml,the average start oral of feeding was(3.0±0.4)h,the average drain removal was(4.1±0.5)d,and the average postoperative hospital stay was(7.0±1.5)d.All of the patients received postoperative follow-up ranged from 4 to 24months,23.5%(4/17)with ClavienⅠandⅡcomplications postoperatively were managed conservatively.No patient suffered ClavienⅢandⅣcomplications such as anastomotic stenosis,reobstruction,or urinary tract infection postoperatively.Three months after surgery,the renal pelvis anteroposterior diameter was(1.8±0.3)cm,which was significantly smaller than that of peroperation[(3.5±0.3)cm,P<0.05],a diuretic T1/2 showed the improvement of differential renal function without urinary obstruction,and the average postoperative differential renal function was(39.7±1.8)%,which was not significantly different with peroiperation[(36.2±1.3)%,P>0.05].Conclusions:Robotic-assisted laparoscopic pyeloplasty is safe and effective for recurrent obstruction in children.

关 键 词：机器人辅助腹腔镜手术 肾盂成形术 儿童 肾积水 肾盂输尿管连接部再梗阻 

分 类 号：R692.2[医药卫生—泌尿科学]