经脐单切口腹腔镜肾盂成形术中长期随访及并发症分析

Follow-up and complication analysis of the single-port transumbilical laparoscopic pyeloureteroplasty

目的 对经脐单切口三通道腹腔镜肾盂成形术的并发症进行总结分析.方法 回顾性分析2009年8月至2014年12月我院收治的162例行经脐单切口腹腔镜肾盂成形术患儿的病例资料.男139例,女23例.年龄1个月～14岁,中位年龄2岁.左侧127例,右侧32例,双侧3例.162例患儿术前均行B超、肾动态显像、磁共振泌尿系水成像等检查,明确梗阻部位位于肾盂输尿管连接处.采取Satava分级系统及Clavien分级系统分别评估术中、术后并发症.将SatavaⅡ级及以上、Clavien Ⅲ级及以上定义为严重并发症.结果 162例术中均未发生血管及腹腔脏器损伤,出血少、均未输血,术中无严重并发症发生.术后143例获随访,随访时间6个月～5年.其中23例（16.1％）发热（＞38.0℃）（Clavien Ⅰ级）,2例（1.4％）尿外渗、肾周积液（Clavien Ⅰ级）,分别予对症处理后好转.术后反复发热性尿路感染7例（4.9％）（Clavien Ⅱ级）;术后5例吻合口部位梗阻再次手术（Clavien Ⅲb级）,2例拔管时大网膜脱出予以清创处理（Clavien Ⅲa级）,严重术后并发症发生率为4.9％.结论 经脐单切口腹腔镜肾盂成形术术后存在一定的并发症,但严重并发症发生率低,总体预后良好.

Objective To summarize the complications of the single-port transumbilical laparoscopic pyeloureteroplasty.Methods From August 2009 to December 2014, 162 surgical procedures were performed in our institute with the single-port transumbilical laparoscopic pyeloureteroplasty.Medical records of each procedure were retrospectively evaluated.139 patients were male and 23 female, aged from 1 month to 14 years and the median age of 2 years.127 patients were operated on the left side and 32 on the right side.3 patients were operated on the bilateral side.All children were supplemented with preoperative ultrasound, renal dynamic imaging and MRU to identify the ureteropelvic junction obstruction.Intraoperative and postoperative complications were graded according to the Satava and Clavien classifications respectively.Major complications were defined as Satava grade Ⅱ or higher, and Clavien grade Ⅲ or higher.Results There was no injury of vascular or visceral organs and no blood transfusion, and there was no serious intraoperative complications.One hundred and forty-three cases were followed up, and 23 cases （16.1%）presented with postoperative fever （〉 38 ℃C） （Clavien Ⅰ）, 2 cases （1.4%） with urinary extravasation diagnosed by perirenal fluid collection（Clavien Ⅰ）.All these cases recovered after being given symptomatic treatment.7 cases （4.9%） presented with postoperative repeated urinary infection （Clavien Ⅱ）.5 cases received postoperative reoperation due to the obstruction of the anastomic site （Clavien Ⅲ b）, and 2 cases were under debridement as the greater omentum was drawn out along with the negative pressure drainage tube（Clavien Ⅲ a）.In summary, the incidence of severe postoperative complications was 4.9%.Conclusions Though there existed some postoperative complications of the single-port transumbilical laparoscopic pyeloureteroplasty, the incidence of serious complications was low and the overall prognosis could be good.