腹腔镜下与开放手术半肾切除治疗小儿重复肾的疗效比较

Comparison of laparoscopic and open partial nephrectomy for duplication anomalies in children

目的比较腹腔镜下和开放手术半肾切除治疗小儿重复肾的疗效。方法先天性重复肾患儿64例。平均年龄17个月。开放手术组36例，腹腔镜下手术组28例。开放组平均年龄18个月，男19例，女17例；输尿管异位开口15例、输尿管膨出18例、膀胱输尿管反流2例、肾盂输尿管连接处梗阻1例。腹腔镜组平均年龄16个月，男18例，女10例；输尿管异位开口9例、输尿管膨出16例、膀胱输尿管反流3例。2组患儿年龄、病种比较差异无统计学意义（P〉0．05）。结果腹腔镜组术中转开放手术2例。2组患儿术中术后未发生外科并发症。开放组平均手术时间2．5h，手术前后血红蛋白差均值2．64g，术后引流量平均91．4ml，引流天数平均4．2d，住院天数平均19．3d；腹腔镜组分别为2．9h、1．45g、55．4ml、3．4d和14．3d；2组比较差异均有统计学意义（P〈0．05）。结论腹腔镜下半肾切除术治疗小儿重复肾畸形半肾无功能安全有效，与开放手术比较手术创伤小、术中出血量少、术后疼痛和住院时间短。

Objective To compare the outcome of laparoscopic with open partial nephrectomy for duplication anomalies. Methods A total of 64 patients with mean age of 17 months were divided into 2 groups. Open group consisted of 36 patients, and laparoscopic group consisted of 28 patients. In open group, there were 19 boys and 17 girls, 15 cases were of ectopic ureter, 18 of ureterocele, 2 of vesicoureteral reflux （VUR） and 1 of ureteropelvic junction obstruction. Mean age was 18 months. In laparoscopic group, there were 18 boys and 10 girls, 9 were of ectopie ureter, 16 of ureterocele and 3 of VUR. Mean age was 16 months. There were no significant differences in age and dis eases. Results There were 2 conversion to open surgery in laparoscopic group and no other intra-operative and post-operative complications in 2 groups. Mean duration of operation was 2. 5 h for open group, the difference of pre- and post-operation hemoglobin was 2.64 g, the volume of drainage was 91.4 ml, the time of drainage was 4.2 d and mean hospital stay was 19.3 d. In laparoscopic group, the figures were 2.9 h, 1.45 g, 55.4 ml, 3.4 d and 14.3 d, respectively. The differences of the figwres were significant between the 2 groups （P〈0.05）. Conclusion Laparoscopic partial nephrectomy is effective and safe for the treatment of duplicated kidney with a dysfunctional moiety.