机器人辅助单孔腹腔镜手术在儿童重复肾治疗中的探索  

Exploration of robot assisted laparoscopic single-port surgery in children with duplex kidney

作　　者：郭云凯 高贺云 张文[1] 宋学敏[2] 赵国艳[3] 余山桢 胡涛 李庚 杜国伟 骆明双 Guo Yunkai;Gao Heyun;Zhang Wen;Song Xuemin;Zhao Guoyan;Yu Shanzhen;Hu Tao;Li Geng;Du Guowei(Department of Pediatric Surgery,Zhongnan Hospital of Wuhan University,Wuhan 430071,China;Department of Anesthesiology,Zhongnan Hospital of Wuhan University,Wuhan 430071,China;Operating Room,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 [2]武汉大学中南医院麻醉科,武汉430071 [3]武汉大学中南医院手术室,武汉430071

出　　处：《临床小儿外科杂志》2024年第9期850-856,共7页Journal of Clinical Pediatric Surgery

基　　金：武汉大学中南医院学科能力建设项目(YYXKNLJS2024020)。

摘　　要：目的探讨第四代达芬奇(Xi)机器人辅助单孔腹腔镜手术在儿童重复肾手术中的应用技巧及临床疗效。方法本研究为回顾性研究, 收集武汉大学中南医院小儿外科于2020年6月到2023年6月行单孔机器人手术治疗的10例重复肾患儿临床资料。其中男1例、女9例, 年龄22天至83个月。完全性重复肾畸形8例, 不完全性(Y型输尿管)重复肾畸形2例。临床表现为发热5例, 反复泌尿系感染7例, 尿道口溢尿2例, 腹痛3例。患儿术前均行泌尿系B超、泌尿系磁共振水成像(magnetic resonance urography, MRU)或CT尿路造影(computed tomography urography, CTU), 8例行二乙基三胺五乙酸核素肾动态显像(diethyltriamine pentaacetic acid, DTPA)。2例肾功能≤10%, 1例为发育不良肾, 1例为复发性上组肾积水;3例行排尿性膀胱尿路造影(voiding cystourethrography, VCUG)。手术方式包括输尿管输尿管吻合术5例, 半肾切除术2例, 输尿管膀胱再植术2例, 肾盂成形术1例。术后1、3、6个月复查彩超、尿常规及尿培养, 观察有无输尿管扩张或狭窄、输尿管反流及泌尿系感染。随访6~42个月。结果手术均在机器人辅助单孔腹腔镜下完成, 无一例中转开腹手术。输尿管输尿管吻合术手术时间(134.4±24.8)min, 住院时间(7.0±2.7)d;半肾切除术手术时间(162.5±53.0)min, 住院时间(7.5±0.7d);输尿管膀胱再植术手术时间(114.5±21.9)min, 住院时间(5.5±0.7)d;肾盂成形术手术时间141 min, 住院时间6 d。输尿管输尿管吻合术患儿中, 1例出现吻合口漏, 经抗感染、充分引流后症状好转出院, 复查无输尿管狭窄;1例出现尿路感染伴发热, 经足量应用抗生素后症状消失;1例输尿管膀胱再植术患儿术后2年行B超引导下输尿管造影, 提示存在膀胱输尿管反流2级, 无泌尿系感染, 未予特殊处理。结论单孔机器人手术安全、可行, 但对医师、助手、麻醉师及器械护士的团队配合及操作技Objective To explore the applications and efficacy of IV generation Da Vinci(XI)robot assisted single-port laparoscopy in children of duplex kidney(DK).Methods From June 2020 to June 2023,the relevant clinical data were retrospectively reviewed for 10 DK girls undergoing robot assisted single port laparoscopy.Age range was(0.75-83)month.The clinical manifestations included fever(n=5),urinary tract infections(n=7),urethral discharge(n=2)and abdominal pain(n=3).Preoperative examinations of ultrasonography,magnetic resonance urography(MRU)and computed tomography urography(CTU)were performed.Diethyltriamine pentaacetic acid(DTPA)imaging(n=8)and voiding cystourethrography(VCUG,n=3)were conducted.There were renal function≤10%(n=2),underdeveloped kidney(n=2)and recurrent upper group hydronephrosis(n=1).The procedures included ureteroureterostomy(n=5),heminephrectomy(n=2),ureterovesical reimplantation(n=2)and pyeloplasty(n=1).Results All procedures were performed under robot assisted single port laparoscopy without any conversion into open surgery.For ureteroureterostomy,mean operative duration was(134.4±24.8)min and mean hospitalization stay(7±2.7)day;for heminephrectomy,mean operative duration was(162.5±53)min and mean hospitalization stay(7.5±0.7)day;for ureterovesical reimplantation,mean operative duration was(114.5±21.9)min and mean hospitalization stay(5.5±0.7)day;for pyeloplasty,mean operative duration was 141 min and mean hospitalization stay 6 days.Doppler ultrasonography and urinary routine/culture were regularly rechecked postoperatively to observe whether or not there was an onset of ureteral dilation/stenosis,ureteral reflux or urinary tract infections.The follow-up period was(6-42)month.One case of postoperative anastomotic fistula improved after proper anti-infection and sufficient drainage.Another case of urinary tract infection with fever disappeared after antibiotic dosing.One child of ureteral bladder replantation was diagnosed with gradeⅡVUR by ureterography under B-ultrasonic guidance at Ye

关 键 词：重复肾 机器人手术 腹腔镜检查 肾切除术 

分 类 号：R69[医药卫生—泌尿科学]