小儿经脐单孔腹腔镜下肾盂成形术的初步经验

Transumbilical laparoendoscopic single-site pyeloplasty in infants and children： initial experience

目的探讨经脐单孔腹腔镜（LESS）下手术治疗小儿肾盂输尿管连接处梗阻的手术技巧和临床应用价值。方法2010年6—12月对24例肾盂输尿管连接处梗阻患儿行经脐LESS下离断式肾盂成形术。男16例，女8例。年龄2～62个月，平均14个月。左侧18例，右侧6例。腔镜下用5．0可吸收线行离断式肾盂输尿管吻合，经吻合口顺行放置双J管。手术均由同一医师完成。结果24例手术均获成功，无中转开放手术，脐孔外无添加鞘管或切口，术中无并发症发生。术中发现异位血管2例。手术时间70～300min，平均145min；出血量5～20ml，平均10ml；术后腹腔引流管引流2～9d；术后住院时间6～10d，平均7d。术后发生尿漏2例，分别于术后第4、7天停止。采用超声和利尿性肾核素扫描检查进行随访，随访时间3～12个月，平均6个月。术后。肾盂直径明显减少23例，肾盂直径减少不明显1例，但分。肾肾小球滤过率由术前29ml／min增至术后6个月46ml／min。结论小儿经脐LESS肾盂输尿管成形术安全有效，患儿美观效果满意。

Objective To present the surgical technique of transumbilical laparoendoscopic singlesite pyeloplasty （LESS-P） for pediatric patients with ureteropelvic junction obstruction （UPJO）. Methods Twenty-four pediatric patients with UPJO had transumbilical LESS-P performed by the same surgeon from June to December 2010. Sixteen patients were male and eight female aged from 2 to 62 months with an average age of 14 months. Eighteen patients had obstruction on the left side and six on the right side. Dismem- bered LESS-P was carried out with the Anderson-Hynes anastomosis where 5-0 sutures were uswed over a double J ureteric stent. Results All operations were successful. None was converted to open surgery and no additional sheath tube or incision besides the umbilicus was needed. No intraoperative complications occurred. Ectopic blood vessels were found in two patients during surgery. The mean operative time was 145 rain, and the average blood loss about 10 ml. Abdominal drainage tubes remained for 2 -9 d after surgery. The mean postoperative hospital time was 7 d. Two patients had postoperative urinary fistula, which naturally disappeared at 4 and 7 d postoperation, respectively. Follow-up with uhrasound and diuretic renal scintigraphy found 23 patients had significantly decreased renal pelvis diameter, the remaining case showed no obvious change, but diuretic renography showed significantly improved excretion. Conclusions Pediatric transumbilical LESS-P could be safe and effective. LESS-P could achieve comparable clinic outcomes to standard laparoscopy.