腹腔镜下重复肾半肾切除术手术路径探讨

Which laparoscopic surgery approach is better for a non-functioning moiety in a duplex kidney in infants and children

目的 探讨经后腹腔镜途径和改良经脐腹腔镜途径实施小儿腹腔镜下重复肾半肾切除术的效果,评估两种手术途径的临床价值.方法 回顾性分析2006年9月至2010年10月北京军区总医院附属八一儿童医院等收治的腹腔镜重复肾半肾切除术患儿临床资料.后腹腔镜组27例,为2006年9月至2009年9月连续收治的病例;改良经脐腹腔镜组18例,为2009年10月至2010年10月连续收治的病例.两组术后均经彩色超声和ECT随访,随访时间1～24个月.结果 两组均顺利完成手术,无中转开放手术病例.后腹腔镜组与改良经脐腹腔镜组在平均手术时间[85（55～132）min VS 73（50～124）min] 、术中出血量[15 （8～48） mL VS 13 （10～34） mL]、术后住院时间[6（4～5）d VS 5（4～10）d]上比较均无统计学意义（P值均〉0.05）.两组术后均未发现下肾功能丧失或肾萎缩.结论 经后腹腔镜途径和改良经脐腹腔镜途径行腹腔镜下半肾切除术,均是可行的微创手术方式,经后腹腔镜途径入路直接,对肠道干扰少;改良经脐腹腔镜途径可以获得更好的美容效果,对输尿管末端的处理更完整,更适合1岁以下婴儿.

Objective To report the outcomes of laparoscopic heminephrectomy for pediatric duplex kidney using retroperitoneal approach and modified transumbilical approach （MTA） and assess their clinical values. Methods Laparoscopic heminephrectomies performed from Sept. 2006 to Sept. 2010 were retrospectively analyzed using retroperitoneal approach in 27 patients and using MTA in 18 patients, respectively. All patients were followed up for 1 to 24 months and accepted postoperative uhrasonography and 99mTc-DTPA scintigraphy. Results All operations were completed successfully without conversion into open surgery and need of intraoperative or postoperative blood transfusion. For retroperitoneal approach, the average operating time was 85 minutes; the estimated average blood loss was 15 mL; average hospital stay was 6 days. For MTA , the average operating time was 73 minutes; the estimated average blood loss was 20 mL; the average hospital stay was 5 days. loss of renal function or atrophy were not found in all patients by postoperative follow - up ultra- sonography and 99mTc-DTPA scintigraphy. There was no statistical difference in operating time, blood loss and postoperative hospital stay between two approaches （ P 〉 0.05 ）. Conclusions Both retroperitoneal and MTA laparoscopic heminephrectomies are feasible, minimally invasive surgery. Retroperitoneal approach can directly target to kidney and has fewer complications caused by intestinal disturbances. By contrary, MTA has better cosmetic effect and better treatment for ureteral end, and is more suitable for infant under age one.