微创开放切口肾切除术治疗儿童多房性肾囊性变

Minimally Invasive Open Nephrectomy for Multicystic Dysplastic Kidney in Children

目的总结微创开放切口肾切除术治疗小儿多房性肾囊性变(MCDK)的初步经验。方法回顾性分析2008年5月-2010年10月本院连续开展的微创开放切口肾切除术治疗小儿MCDK 15例的临床资料。患儿均为单侧MCDK,均经CT、放射性核素显像和超声检查确诊。对侧功能肾脏未发现异常。男12例,女3例;右侧5例,左侧10例。手术均经腹膜后间隙完成。取腰肋部开放切口,长度1.5～2.0 cm(平均1.7 cm)。手术时年龄3个月～5.6岁(平均2.4岁)。手术时间30～45 min(平均34.6 min)。所有手术术中估计出血量<5 mL。术后静脉予抗生素预防感染2～4 d。结果本组手术均成功。患儿术后住院2～4 d(平均2.8d)。全部患儿术后随访未发现术后并发症。结论微创开放切口肾切除术治疗儿童MCDK可以达到通过开放切口实现微创治疗的目的。本方法手术时间短,美容效果好,术后住院时间短,且安全、有效,容易开展。

Objective To evaluate the preliminary experience of the operation for multicystic dysplastic kidney（MCDK） with a minimally invasive open nephrectomy in children. Methods A retrospective review of the consecutive minimally invasive open nephrectomies in the last two years was performed.Fifteen patients（12 boys and 3 girls;right 5 cases and left 10 cases） with unilateral MCDK had the operation by using an open flank incision.All patients were diagnosed by CT,emission computerized tomographic and ultrasound.No anomaly in the contralateral functioning kidney was found.Posterior subcostal muscle splitting approach was utilized.The mean incision was 1.7 cm long（range：1.5 to 2.0 cm）.The average age at the age of surgery was 2.4 years（range：3 months to 5.6 years）.The mean operative time was 34.6 min（range：30 to 45 min）.The estimated blood loss was less than 5 mL in every patient.Prophylactic intravenous antibiotics were administered for 2 to 4 days postoperatively. Results The operation was successful in all children.The average length of hospital stay was 2.8 days（range：2 to 4 days） postoperatively.No complications were seen in follow-up after surgery. Conclusions The minimally invasive approach to open nephrectomy can be performed through a small incision with minimal morbidity.The procedure is superior with regard to operative time,cosmesis,and length of stay.It is a safe and effective treatment choice for MCDK and can be easily performed in children.