机器人辅助腹腔镜肾盂成形术治疗≤6月龄小婴儿肾积水44例  

Robot-assisted Laparoscopic Pyeloplasty for 44 Cases of Hydronephrosis in Infants Younger Than 6 Months Old

作　　者：王双双 王晓晖 张书峰 高建 王霖 史若乂 孙英豪 Wang Shuangshuang;Wang Xiaohui;Zhang Shufeng(Department of Pediatric Surgery,People’s Hospital of Zhengzhou University,Henan Provincial People’s Hospital,Zhengzhou 450003,China)

机构地区：[1]郑州大学人民医院、河南省人民医院小儿外科,郑州450003

出　　处：《中国微创外科杂志》2025年第2期87-91,共5页Chinese Journal of Minimally Invasive Surgery

基　　金：河南省科技攻关项目(222102310133)。

摘　　要：目的探讨机器人辅助腹腔镜肾盂成形术(robot-assisted laparoscopic pyeloplasty,RALP)治疗≤6月龄小婴儿肾盂输尿管连接部梗阻(ureteropelvic junction obstruction,UPJO)肾积水的疗效及安全性。方法回顾性分析2021年1月~2023年12月RALP治疗44例≤6月龄小婴儿UPJO肾积水的临床资料。年龄5天~6个月,(72.3±49.7)天;体重2.9~8.5 kg,(5.7±1.6)kg。术前彩超检查肾盂前后径(anteroposterior diameter,APD)(30.2±9.5)mm,肾实质最薄处厚度(2.6±1.2)mm。使用达芬奇Xi机器人手术系统,充分暴露肾盂输尿管连接部狭窄段,剪刀修剪肾盂及输尿管,6-0单股线吻合肾盂输尿管。结果44例手术均顺利完成,无中转传统腹腔镜或开放手术,无术中并发症。手术时间105~245 min,平均179.8 min,术中出血量2~10 ml,平均4.9 ml。拔除双J管后6个月复查彩超,APD(10.5±6.3)mm,较术前显著减小(配对t检验,t=19.985,P=0.000),肾实质最薄处厚度(6.8±1.7)mm,较术前显著增加(配对t检验,t=18.420,P=0.000)。拔除双J管后随访6~12个月,无吻合口狭窄、漏尿、再次梗阻。结论RALP治疗≤6月龄小婴儿UPJO肾积水安全有效。Objective To evaluate the efficacy and safety of robot-assisted laparoscopic pyeloplasty(RALP)in the treatment of obstructive hydronephrosis at ureteropelvic junction in infants≤6 months old.Methods Clinical data of 44 infants with ureteropelvic junction obstruction(UPJO)and hydronephrosis treated by RALP from January 2021 to December 2023 were analyzed retrospectively.The average age was(72.3±49.7)d(range,5 d-6 months old),and the average weight was(5.7±1.6)kg(range,2.9-8.5 kg).Preoperative ultrasonography showed that the anteroposterior diameter was(30.2±9.5)mm and the thinnest part of the renal parenchyma was(2.6±1.2)mm.By using the da Vinci Xi robotic operating system,the narrow segment of the ureteropelvic junction was fully exposed,the renal pelvis and ureter were trimmed with scissors,and the ureter was anastomosed with 6-0 single strands.Results All the 44 operations were completed successfully without conversion to traditional laparoscopic or open surgery.No intraoperative complications occurred.The operation time was 105-245 min(mean,179.8 min),and the intraoperative blood loss was 2-10 ml(mean,4.9 ml).Re-examinations of ultrasonography at 6 months after removal of double J tube showed that the anteroposterior diameter was(10.5±6.3)mm,which was significantly decreased than that before operation(paired t test,t=19.985,P=0.000),and the thinnest part of the renal parenchyma was(6.8±1.7)mm,which was significantly increased than that before operation(paired t test,t=18.420,P=0.000).The patients were followed up for 6-12 months after removal of double J tube.There were no complications such as anastomotic stricture,urine leakage,or recurrence of obstruction.Conclusion RALP is safe and effective in the treatment of UPJO and hydronephrosis in infants younger than 6 months old.

关 键 词：机器人辅助腹腔镜肾盂成形术 婴儿 肾积水 肾盂输尿管连接部梗阻 

分 类 号：R726.9[医药卫生—儿科]