带线套管针辅助悬吊固定法在婴儿腹腔镜离断肾盂成形术中的应用

Laparoscopic pyeloplasty in infants: assisted suspension fixation technique for ureteropelvic junction obstruction

目的观察带线套管针辅助悬吊固定法在婴儿肾盂输尿管连接处狭窄腹腔镜手术治疗中的作用。方法回顾分析2008年12月至2017年2月32例经腹腔镜治疗婴儿肾盂输尿管连接处梗阻患者资料,年龄平均9.4个月(50 d^2岁),16例采用经腹膜后入路,16例经腹腔入路。按术中每组是否采用悬吊法分两个亚组。比较手术及吻合时间、并发症、术后住院时间等。结果经腹和腹膜后入路悬吊法完成吻合口缝合时间均较非悬吊法缩短,差异有统计学差异(P<0.05)。术前超声测肾盂分离值、术后拔管时间、术后住院时间对比两个亚组差异无统计学意义(P>0.05)。总手术时间经腹腔入路(148±30)min,经腹膜后入路(189±48)min,差异有统计学意义(P<0.05)。所有病例手术前超声测量肾盂分离值(3.7±0.6)cm,术后一年复查超声肾盂分离值(1.8±0.5)cm,差异无统计学意义(P>0.05)。1例术后出现铜绿假单孢菌感染,按药敏结果治疗后控制,1例出现吻合口狭窄,经输尿管球囊扩张,2例暂观察中。手术治愈率93.75%(30/32)。无其他并发症。结论婴儿腹腔镜肾盂离断成形术安全有效,经腹入路手术时间较腹膜后入路短,悬吊法便于缝合有助于降低手术难度。

Objective To evaluate the efficacy and safety of an assisted suspension fixation technique in infants receiving laparoscopic pyloplasty for ureteropelvic junction obstruction （UPJO）. Methods The medical records of 32 infants who underwent laparoscopic pyloplasty for UPJO between December 2008 and February 2017 were reviewed retrospectively. Median age at surgery was 9.4 months （range 1.6-24.0 months）. Among those, 16 patients were operated on via postperitoneal approach and 16 cases by transperitoneal approach. According to the application or not of the assisted suspension fixation technique involving avasocan hollow needle and silk suture, each group was divided into two subgroups. Data on operating time, ureteropelvic anastomotic time, complications, and postoperative length of stay were collected. Results There were significant differences in the median total operation time [（148-30） min vs （189±48） min, P〈0.05] and ureteropelvic anastomotic time [（100±21） min vs （40±11） min, P〈0.05] between the transperitoneal and postperitoneal approach groups. There were significant differences in the ureteropelvic anastomotic time between two subgroups viapostperitoneal approach [（110±20） min vs （46±13） min, P〈0.05]. No significant differences were noted in anteroposterior diameter from ultrasound before operation, the double-J stent stay days and postoperative stay days. US revealed decreased renal pelvis dilation in all cases. One patient had Pseudomonas aeruginosa infection and were treated by Sulperazon. One patient developed anastomic stenosis and received balloon dialation. Two cases were under observation. An overall success rate was 93.75% （30/32）. Conclusion The laparoscopic pyeloplasty is safe and effective to treat UPJO in infants.The transperitoneal approach is associated with a shorter operation time than the retroperitoneal approach. The assisted suspension fixation technique is helpful to ureteropelvic anastomic suture under laparoscopy.