腹腔镜肾盂成形术在治疗幼小婴儿肾盂输尿管连接部梗阻中的应用

Application of laparoscopic pyelplasty in surgical treatment of neonatal ureteropelvic junction obstruction

目的 总结腹腔镜肾盂成形术治疗婴幼儿肾盂输尿管连接部梗阻的经验.方法 本组共31例肾盂输尿管连接部梗阻的患儿,平均年龄为8.6个月,均为产前B超发现并随访至出生后,按照相应的分级进入手术治疗的临床路径;严格按照家长意见,患儿接受腹腔镜肾盂成形术,相应手术过程被记录并分析.结果 31例患儿手术成功29例,2例转为小切口辅助,手术时间110～230 min,平均145 min,术中出血均小于5 ml;术后恢复良好,未出现尿外渗和吻合口狭窄.分别于术后3个月、6个月行B超检查,均未再出现肾盂增大,未出现肾盂肾盏分离加大趋势,手术治疗效果良好.结论 ①腹腔镜手术在治疗婴幼儿肾盂输尿管连接部梗阻中有良好可靠应用,相对于传统手术腹腔镜具有创伤小,恢复快等优点,代表了将来的发展方向,但具体手术需要较丰富的腔镜操作经验;②婴幼儿腹腔镜肾盂成形术中我们总结一系列诸如全面术前准备、精细手术操作、尽量增加套管针穿行距离、顺利留置双＂J＂管等经验;③腹腔镜肾盂成形术在幼小婴儿手术治疗中的应用,仍需更多的总结经验.

Objective To summarize the experience in laparscopic pyelplasty of neonatal ureteropelvic junction obstruction. Methods 31 patients were retrospective analyzed, which＇s mean age were 8.6 months. All the cases were detected at ante partum, and close inspection follows up until juvenal infant period. Every baby that had been accepted the operation was in strict accordance with the grade of SFU and the desire of the parents. The procedures of laparoscopic pyelplasty were retrospective recorded and analyzed. Results 29 of 31 cases were succeeded. But 2 cases turn to small incision operation. The procedures cost 110-230 minutes, which＇s mean time was 145 minutes. All the cases recoveries well. Cases were follow up the examinations of ultrasonogrophy at 3, 6 months after the operation. No disassociation between calices renales and pelvis renalis was detected. And it is proved that the operations are successful. Conclusions 1. Application of laparoscopic pyelplasty in surgical treatment of neonatal ureteropelvic junction obstruction is reliable. Compared with the traditional operation. laparoscopic pyelplasty has the advantages of smaller trauma and better recovery. And it represents development direction in the future. But it needs rich experience in this operating practice. 2.We have summarized many experiences in laparscopic pyelplasty of neonatal ureteropelvic junction obstruction. 3. But application of laparoscopic pyelplasty in too little babies still exist many disputes,and need more practice.