后腹腔镜手术在小儿泌尿外科疾病中的应用

Retroperitoneal laparoscopy for the treatment of pediatric urological diseases （report of 48 cases ）

目的总结后腹腔镜手术治疗小儿泌尿外科疾病的经验。方法2004年3月至2006年4月共完成后腹腔镜小儿泌尿外科手术48例，包括肾盂输尿管连接处狭窄28例、肾发育不良3例、肾囊肿3例、肾上腺节细胞神经瘤8例、输尿管息肉3例、输尿管结石2例、肾上腺皮质增生症1例。其中男32例，女16例，平均年龄7岁。结果48例手术均获成功。平均手术时间：离断性肾盂成形术95min、发育不良肾切除术45min、肾囊肿去顶术42min、肾上腺节细胞神经瘤切除术51min、输尿管息肉切除术70min、输尿管切开取石术60min。平均术中出血量18ml。术中无脏器损伤及气体栓塞等严重并发症。术后平均住院时间8d。输尿管取石术后出现尿路感染1例，离断性肾盂成形术后吻合口狭窄和术后漏尿各1例，相应处理后均痊愈。平均随访时间6（1～24）个月，患者症状消失或好转，未见原发病复发。结论小儿后腹腔镜手术安全可行，具有切口小、出血少、损伤轻、术后恢复快和并发症少等优点，值得临床进一步推广使用。

Objective To report our experience with the retroperitoneal laparoscopy in pediatric urology, Methods From March 2004 to April 2006,48 retroperitoneal laparoscopic surgeries were performed in children with a mean age of 7 years old. The medical and surgical records were evaluated retrospectively. The following aspects were considered~ operative techniques,duration of surgery, intraoperative blood loss, success, complications; details concerning recovery, and follow up. Results Retroperitoneal laparoscopic operations were successfully performed in all patients. The average operatire time was 95 rain for dismembered pyeloplasty, 45 rain for simple nephrectomy for renal dysplasia, 42 rain for renal cyst decortication, 70 rain for ureteroureterostomy for polyp of ureter,60 rain for ureterolithotomy, 51 rain for of adrenal paraganglioma resection. The mean blood loss was 18 ml. The mean length of hospital stay was 8 d. No serious intraoperative complications occurred. During the follow-up of 1 to 24 months, one urinary infection occurred after ureterolithotomy and 1 re-stricture and 1 urinary leakage for pyeloplasty, respectively. Conclusions Retroperitoneal laparoscopic surgeries are safe and effective in pediatric urology. The benefits include small incision, minimal invasive, less bleeding and quick recovery. More studies should be done to promote its further applications for the treatment of urologic diseases.