腹腔镜下半肾及输尿管切除治疗小儿重复肾

Laparoscopic heminephrectomy in children patients with duplex kidneys

目的分析腹腔镜下半肾及输尿管切除治疗小儿重复肾输尿管的病例,总结手术技巧及经验。方法回顾分析2015年12月至2016年11月于我院因重复肾接受腹腔镜下选择性血管阻断切除上半肾的儿科患者资料。本组纳入患者11例,男4例,女7例。年龄6个月至8岁。所有患者完成术前准备后全麻下手术治疗。手术采用3通道经腹腔入路腹腔镜下上半肾及其输尿管切除,术中在辨别并处理上肾输尿管后选择性阻断上肾血管后切除上半肾。记录手术时间、失血量、术后创面引流量、术中副损伤及术后并发症。术后3 d复查患肾超声,血、尿常规及血肾功。门诊随访1~6月。结果所有手术均顺利完成,无中转开放及输血病例。平均手术时间133(110~154)min,术中出血量14(10~20)ml。术后6 h进食,引流管停留时间3 d,平均术后总引流量16(5~38)ml。术后1 d下地活动。术后平均住院时间5 d。所有患者获得术后1~6月随访。手术前后血红蛋白水平差异无统计学意义。无肾萎缩及输尿管残端感染出现。结论腹腔镜下半肾及输尿管切除治疗小儿重复肾输尿管安全有效,手术创伤小,可以避免保留肾的缺血再灌注损伤,术中、术后失血少,值得临床推广。

Objective To evaluate the effect of laparoscopic heminephrectomy in treatment of children patients with duplex kidneys. Method Eleven patients（4 males and 7 females） who had been diagnosed with duplex kidney and received laparoscopic heminephrectomy in Pediatric Surgery Department of Sichuan Academy of Medical Sciences Sichuan Provincial People＇s Hospital between December 2015 and November 2016 were reretrospectively reviewed. The operations were carried out under general anaesthesia. During the operation the ＂highly selective clamping of renal vascular＂ was employed. Patients＇ characteristics, presenting symptoms, operative time, and blood loss, early and late complications were all collected retrospectively. Result All 11 patients received laparoscopic heminephrectomy with highly selective clamping of renal vascular. All operations went smoothly without converted to open surgeny and blood transfusion. Average operative time was 133 min（range 110-154 min）, blood lose was 14 ml（range 10-20 ml）, mean hospital stay after operation was 5 days. On follow-up of 1-6 months no symptomatic urinary tract infections（UTIs） and atrophic kidney were detected. Conclusion Laparoscopic heminephrectomy is a minimal invasive procedure for the treatment of pediatric patients. Highly selective clamping of renal vascular is important for the preservation of renal function and also the blood loss control.