单孔加一孔技术在达芬奇机器人儿童泌尿外科手术中的疗效分析  

Application experience and effect of single-port-plus-one technology in Da Vinci robotic pediatric urological surgery

作　　者：张玉茹 陈江龙 林珊[1] 汤坤彬 何玉锋 尤光旭 徐迪[1] Zhang Yuru;Chen Jianglong;Lin Shan;Tang Kunbin;He Yufeng;You Guangxu;Xu Di(Shengli Clinical Medical College of Fujian Medical University,Pediatric Department of Fuzhou University Affiliated Provincial Hospital,Fuzhou 350001,China)

机构地区：[1]福建医科大学省立临床医学院、福州大学附属省立医院小儿外科,福州350001

出　　处：《中华泌尿外科杂志》2025年第3期213-218,共6页Chinese Journal of Urology

摘　　要：目的探讨达芬奇机器人单孔加一孔技术在儿童常见泌尿系统手术应用中的有效性和安全性。方法回顾性分析2022年5月至2023年11月福州大学附属省立医院小儿外科行单孔加一孔机器人辅助腹腔镜手术的59例患儿的临床资料。男44例,女15例;中位年龄36(6,108)个月。其中肾盂输尿管连接处狭窄27例,术前肾盂前后径(31.83±6.59)mm;美国胎儿泌尿外科协会(SFU)分级Ⅲ级8侧,Ⅳ级19侧;双侧分肾功能差值中位值13.50%(7.18%,31.06%)。膀胱输尿管反流17例,术前排泄性膀胱尿道造影(VCUG)提示膀胱输尿管反流Ⅲ级8侧,Ⅳ级14侧,Ⅴ级4侧;双侧分肾功能差值中位值18.58%(6.04%,28.30%)。梗阻性巨输尿管10例,术前肾盂前后径(22.17±7.64)mm,输尿管最大直径(19.51±3.71)mm,术前双侧分肾功能差值中位值18.02%(5.23%,49.42%)。重复肾输尿管5例,泌尿系磁共振水成像(MRU)提示均为单侧重复肾,重复上肾盂、肾盏伴输尿管重度扩张积水,肾皮质菲薄;其中2例合并输尿管异位开口,1例合并输尿管末端囊肿。肾盂输尿管连接处狭窄患儿行肾盂输尿管离断成形术,膀胱输尿管反流和梗阻性巨输尿管患儿均行输尿管再植术;重复肾输尿管患儿行重复肾切除术。所有患儿均使用达芬奇机器人Xi系统,布孔方式均采用绕脐部取一长2~3 cm的手术切口,放入单孔四通道装置,在直视下根据手术部位在左或右腹置入另一个8 mm操作通道。比较手术前后各项参数变化。结果所有手术均顺利完成,未中转开放或腹腔镜手术。肾盂输尿管离断成形术患儿手术时间(141.52±22.93)min,术后肾盂前后径(12.54±4.05)mm,双侧分肾功能差值为5.60%(2.14%,14.48%),均较术前明显改善(P<0.01);术后SFU分级Ⅰ级13侧,Ⅱ级13侧,Ⅲ级1侧,较术前改善。膀胱输尿管反流患儿的手术时间单侧为(125.00±11.75)min,双侧为(153.22±14.39)min;术后VCUG反流级别Ⅰ级2侧,Ⅱ级、Ⅲ级各1侧,余未见反流ObjectiveTo explore the efficacy and safety of the Da Vinci robotic single-port-plus-one technique in common urological surgeries in children.MethodsThe data of 59 children who underwent robot-assisted single-port-plus-one laparoscopic surgery from May 2022 to November 2023 in Fuzhou University Affiliated Provincial Hospital were retrospectively analyzed.There were 44 males and 15 females,aged 36(6,108)months.Among them,27 cases had ureteropelvic junction obstruction,with a preoperative anterior-posterior diameter of the renal pelvis of(31.83±6.59)mm.The American Society of Fetal Urology(SFU)grading system revealed gradeⅢin 8 sides and gradeⅣin 19 sides.Bilateral renal function showed a difference of 13.50%(7.18%,31.06%).Additionally,17 cases presented with vesicoureteral reflux.Preoperative voiding cystourethrogram(VCUG)indicated reflux gradesⅢ,Ⅳ,andⅤin 8,14,and 4 sides,respectively,with a difference in bilateral renal function of 18.58%(6.04%,28.30%).Ten cases had obstructive megaureter,with a preoperative renal pelvis diameter of(22.17±7.64)mm and a maximum ureteral diameter of(19.51±3.71)mm.The preoperative bilateral renal function difference was 18.02%(5.23%,49.42%).Five cases involved duplicated kidney and ureter.Magnetic resonance urography(MRU)confirmed unilateral duplicated kidneys with associated dilatation of the upper renal pelvis and calyces,hydroureter,thin renal cortex in all 5 patients.Among them,2 cases had ectopic ureteral opening and 1 case had terminal ureteral cyst.Patients with ureteropelvic junction stenosis underwent pyeloplasty,those with vesicoureteral reflux and obstructive megaureter underwent ureteral reimplantation,and patients with duplicated ureters underwent nephrectomy.The Da Vinci robotic surgical system was employed for all procedures.The port placement technique involved a 2-3 cm incision around the navel to insert a single-port four-channel device,followed by the placement of an additional 8 mm operating channel in the left or right abdomen under direct visualiza

关 键 词：机器人手术 儿童泌尿外科 单孔加一孔 安全性 可行性 

分 类 号：R726.9[医药卫生—儿科]