腹腔镜手术在儿童泌尿生殖系统疾病中的应用

Application of Laparoscopic Surgery in Pediatric Genitourinary Diseases

目的探讨腹腔镜手术在儿童泌尿生殖系统疾病中应用的适应证和手术技巧,分析中转开放手术和术后并发症的原因。方法回顾性分析2006年9月-2010年3月通过腹腔镜手术治疗的儿童泌尿生殖系统疾病276例。男256例,女12例,两性畸形8例;年龄6个月～17岁,平均5岁1个月。其中鞘状突高位结扎152例,腹腔型隐睾下降固定62例,精索静脉曲张高位结扎28例,两性畸形性腺探查8例,发育不良异位肾切除7例,气膀胱输尿管再植、肾盂离断式成型各4例,重肾重输尿管切除3例,肾盂切开结石、肾囊肿去顶减压、卵巢肿瘤切除各2例,发育不全原位肾切除、肾上腺肿瘤切除各1例。结果本组共涉及12种泌尿生殖系统疾病。腹腔镜完成手术268例,中转开放手术8例。全组术后并发症6例,其中Trocar穿刺损伤膀胱、鞘膜积液术后复发、精索静脉曲张术后复发各1例,肾脏手术后尿外渗3例。结论绝大部分儿童泌尿生殖系统疾病均可通过腹腔镜手术安全、有效地完成,但应注意具体病例的适应证选择。

Objective To explore the indications and techniques and complications of laparoscopic surgery in pediatric genitourinary di-seases.Methods From Sep.2006 to Mar.2010,276 children from 6 months to 17 years old with genitourinary diseases were treated with laparoscopic surgery,of whom 256 cases were male and 12 cases were female and 8 cases were hermaphrodism.The mean age was 5 years and 1 month.Laparoscopic procedure for spermatic hydrocele was conducted in 152 cases.Laparoscopic orchidopexy for impalpable testis was conducted in 62 cases.Laparoscopic palomo procedure for varicocele was conducted in 28 cases.Laparoscopic exploration for hermaphroditism was conducted in 8 cases.Transperitoneal laparoscopic nephrectomy for hypoplastic kidney was conducted in 7 cases.Retroperitoneal laparoscopic nephrectomy for hypoplasia kidney was conducted in 1 case.Laparoscopic pnuemovesical Cohens operation for megaloureter was conducted in 4 cases.Laparoscopic pyeloplasty for ureteropelvic junction obstruction was conducted in 4 cases.Laparoscopic heminephrectomy for duplicated kidney was conducted in 3 cases,laparoscopic procedure for pelvis stone and renal cyst and ovary tumor was conducted in 2 cases respectively.Laparoscopic adrenalectomy for adrenal gland tumor was conducted in 1 case.Results Two hundred and sixty-eight laparoscopic operations were completed successfully,while 8 operations required conversion to open surgery.There were 6 complications occurred.Bladder trauma 1 case,urinous infiltration 3 cases,hydrocele recurrence after operation 1 case,and varicocele recurrence after operation 1 case.Conclusion Laparoscopic techniques can be used safely and effectively for common pediatric genitourinary diseases.