交叉操作技术在小儿单孔腹腔镜离断性肾盂成形术中的应用

Application of Cross Technique in Pediatric Single Site Laparoscopic Dismembered Pyeloplasty

目的探讨小儿单孔腹腔镜离断性肾盂成形术采用双手可弯曲器械交叉操作模式的可行性和安全性。方法2014年10月～2017年12月我科对30例小儿肾盂输尿管连接部梗阻(ureteropelvic junction obstruction,UPJO)采用经脐单孔腹腔镜离断性肾盂成形术。取环脐缘皱褶处1～1.5 cm切口,置入单孔通道器,双手可弯曲器械交叉操作,裁剪肾盂及输尿管,对位成形吻合。结果 30例手术完全在单孔腹腔镜下完成。手术时间64～140 min,平均101.2 min;出血量1～5 ml,平均2.6 ml;术后腹腔引流1～5 d,平均3.2 d。术后6周拔除双J管。30例随访3～6个月,术后3个月超声提示肾盂前后径明显减少[(4.19±1.02) cm vs.(1.59±0.53) cm,t=17.402,P=0.000],静脉尿路造影可见吻合口通畅,脐周无明显手术瘢痕。结论交叉操作技术应用于单孔腹腔镜离断性肾盂成形术治疗小儿UPJO,大大降低手术难度,安全、可行,术后美容效果满意,值得推广。

Objective To discuss the feasibility and safety of crossed manipulation mode with both arm flexible instrument in pediatric single site laparoscopic dismembered pyeloplasty.Methods A total of 30 pediatric patients with ureteropelvic junction obstruction ( UPJO) who were admitted into our hospital from October 2014 to December 2017 were retrospectively analyzed.The patients received umbilical single site laparoscopic dismembered pyeloplasty.A 1 to 1.5 cm incision was made around umbilical edge folds,and a single-port channel device was imbedded.The pelvis and ureter were tailored through crossed way with both arm flexible instrument,and anastomosis was formed in counterpoint.Results All the operations were performed under single-port laparoscopy.The operation time was 60 - 140 min ( mean,101.2 min).The blood loss was 1 - 5 ml ( mean,2.6 ml).The postoperative abdominal drainage time was 1 - 5 days ( mean,3.2 days).The double J catheter was removed at 6 weeks after operation.The followup visits were carried out in all the patients for 3 - 6 months.The ultrasound findings at 3 months after operation showed a significant decrease in the anteroposterior diameter of pelvis [( 4.19 ± 1.02) cm vs.( 1.59 ± 0.53) cm,t = 17.402,P = 0.000)].Intravenous urography showed a smooth anastomotic stoma,with no obvious operation scar around the umbilicus.Conclusions For pediatric patients with UPJO,the application of crossed way in single site laparoscopic dismembered pyeloplasty can greatly reduce operation difficulty.In addition,the procedure has safety, feasibility and satisfactory postoperative cosmetic results,being worthy of clinical promotion.