单切口腹腔镜肾盂成形术治疗小儿肾盂输尿管连接部梗阻

Laparoscopic-endoscopic single-site surgery for pyeloplasty：preliminary experience in children

目的 总结我院已成功开展的13例小儿单切口腹腔镜肾盂成形术,探讨单切口腹腔镜肾盂成形术治疗小儿肾积水的可行性.方法 2009年11月至2010年5月收治左侧肾积水患儿13例,男11例,女2例,平均年龄35个月（3～103个月）.B超、DTPA示肾盂输尿管连接部梗阻.手术取平卧位,左侧腰部垫高.沿右侧脐环做半环形切口,Hasson法在脐部切口中间放置普通5 mm鞘管,在其两侧穿刺放置2个普通3 mm鞘管,鞘管位于同一切口内.采用30度5 mm目镜,常规3 mm操作器械.在肾盂表面打开结肠系膜.经系膜裂孔将肾盂输尿管连接处提至腹腔内.于肾盂最高点经腹壁做牵引线提起肾盂输尿管连接部,行肾盂裁剪和肾盂输尿管吻合.结果 13例手术均获得成功,无中转开放病例.无术中并发症.平均手术时间218 min（180～240 min）.所有患儿均在术后第一天进食.术后负压球引流4～6 d,术后住院5～7 d.所有病例于术后6周膀胱镜下拔除双J管.术后并发症包括吻合口梗阻1例（7.7%）,反复尿路感染1例（7.7%）.其余患儿术后恢复良好.结论 我们的经验表明单切口腹腔镜肾盂成形术治疗小儿肾积水可取得良好的近期临床效果,但长期效果还需要进一步的随访.

Objective We report our experience of laparoscopic-endoscopic Single-site Surgery （LESS） for Anderson-Hynes pyeloplast. Methods Between November 2009 and April 2010,13 cases of E-NOTES pyeloplasty were performed, all on the left side. DTPA renal isotope and ultrasound confirmed the diagnosis. For LESS technique, the patients were positioned supine. An incision was made on the right circumference the umbilicus. Three conventional ports were inserted through this incision,one 5mm for camera and two 3mm for instruments. Conventional laparoscopic instruments and 30 degree camera were used for the procedures. The pelvis was approached through a mesentery opening. A traction suture was placed through abdominal wall at the rostral side of the pelvis to elevate it. Pyelotomy and anastomosis was carried out. Results All 13 procedures were successfully completed with no conversion. No intra-operative complication occurred. The mean operative time was 218min（ 180-240 min）.The patients could tolerate food intake on postoperative day 1. The duration of perirenal drainage was 4-6days. The hospital stay was 5-7days. Double-J was removed 6 weeks after the operation. Postoperative complications include 1 case of stenosis of anastomosis （7. 7% ） and 1 cases of urinary tract infection （7. 7%）. Conclusions Based on our experience, pyeloplasty could be completed successfully by LESS in children. More data are needed to fully assess the benefit of this technique.