腹腔镜技术在治疗小儿肾重复畸形中的应用

Laparoscopic Partial Nephrectomy for Children with Duplex Kidney

目的探讨腹腔镜半肾切除术治疗小儿肾重复畸形的价值。方法2006年6月-2009年2月对21例小儿肾重复畸形施行腹腔镜半肾切除术。采用三孔或四孔腹腔镜技术,经腹入路,游离肾周组织,结扎切断重肾血管,切除重肾及输尿管,腹膜后放置引流。结果21例手术均成功,无中转开腹。腹腔镜手术操作130-210 min,平均190 min;术中出血量5-10 ml,无手术输血者。术后8-10 h进流食。术后住院时间5-7 d,平均6.2 d。21例患儿术后随访3-28个月,平均20.2月,临床症状消失,B超未见明显异常。结论经腹入路腹腔镜半肾切除术治疗小儿肾重复畸形创伤小,可扩大手术操作空间,清晰暴露手术视野,切除输尿管远端更彻底,术后恢复快,有良好的应用前景。

Objective To explore the value of laparoscopic partial nephrectomy for children with duplex kidney. Methods Between June 2006 and February 2009, we performed laparoscopic partial nephrectomy on totally 21 children with duplex kidney. Three or four trocars were used for the operation. Through transabdominal approach the peri-rena] tissues were freed and the vessels supplying the duplicated kidney were ligated. Afterwards, we resected the duplicated kidney, as well as the ureter, and a subperitoneal drainage tube was indwelt. Results The operation was completed in all of the 21 cases without conversion to open surgery. The mean operation time for laparoscopy was 190 min （range, 130 to 210 min）. The intraoperative blood loss ranged from 5 to 10 ml. No patient received blood transfusion. Liquid diet was given in 8 to 10 hours after the operation. In this series, the postoperative hospital stay ranged from 5 to 7 days with a mean of 6.2 days. Follow-up was available for 3 to 28 months in the cases （mean, 20. 2 months）. During the period, the clinical symptoms disappeared and B ultrasonography showed no abnormalities. Conclusions Providing larger operation space and better exposed surgical field, laparoscopic partial nephrectomy for children with duplex kidney is feasible and safe with quicker recovery.