经脐单一部位三通道腹腔镜下离断式肾盂成形术治疗小儿肾盂输尿管连接部梗阻

Transumbilical Single Site Three-port Laparoscopic Anderson-Hynes Pyeloplasty for Ureteropelvic Junction Obstruction in Children

目的探讨经脐单一部位三通道腹腔镜离断式肾盂成形术治疗小儿肾盂输尿管连接部梗阻(ureteropelvic junction obstruction,UPJO)的临床价值。方法2017年8月~2018年9月我院采用经脐单一部位三通道腹腔镜下离断式肾盂成形术治疗46例UPJO。左侧采用经结肠系膜途径或侧腹膜途径,右侧采用经侧腹膜途径手术。分离显露肾盂输尿管连接部后悬吊并切除病变段,裁剪多余肾盂,采用Anderson-Hynes技术常规吻合肾盂输尿管。结果43例经脐单一部位三通道腹腔镜下离断式肾盂成形术获得成功,3例操作困难改为两部位三通道完成手术,无中转开放手术。肾盂输尿管连接部狭窄38例,输尿管高植入3例,输尿管息肉5例。手术时间94~152 min,平均128 min。术中出血量2~15 ml,平均5 ml。术后住院时间5~10 d,平均6 d。术后6个月患侧肾盂前后径(20.4±0.4)mm,较术前(34.2±2.4)mm明显缩小(t=40.282,P=0.000);分肾功能(36.0±2.1)%,较术前(32.0±4.1)%明显改善(t=-5.710,P=0.000)。手术成功率100%结论经脐单一部位腹腔镜离断式肾盂成形手术治疗小儿UPJO安全、有效,脐外无肉眼可见瘢痕,但手术操作难度较大,需要选择合适的病所并结合术者自身技术水平合理开展。

Objective To investigate the clinical value of transumbilical single site three-port laparoscopic dismembered pyeloplasty for ureteropelvic junction obstruction(UPJO)in children.Methods Transumbilical single site three-port laparoscopic dismembered pyelop lasty was performed in 46 children with UPJO in our hospital from August 2017 to September 2018.The left side was operated through mesocolon or lateral peritoneum,while the right side was operated through lateral peritoneum.The ureteropelvic junction was separated and exposed,then the lesion was suspended and excised,and the redundant pelvis was removed.The ureteropelvic junction was anastomosed by Anderson-Hynes technique.Results The transumbilical single site three-port laparoscopic Anderson-Hynes pyeloplasty was successfully operated in 43 cases,while an additional port was needed in 3 cases.No case was transferred to open surgery.There were 38 cases of ureteropelvic junction stenosis,3 cases of high implantation of ureter and 5 cases of ureteral polyps.The average operation time was 128 min(range,94-152 min).The average intraoperative bleeding was 5 ml(range,2-15 ml).The average hospital stay was 6 days(range,5-10 days)after operation.At 6 months after operation,the anteroposterior diameter of the renal pelvis was(20.4±0.4)mm,which was significantly smaller than that before operation[(34.2±2.4)mm,t=40.282,P=0.000].The separation renal function was(36.0±2.1)%,significantly better than that before operation[(32.0±4.1)%,t=-5.710,P=0.000].Conclusions Transumbilical laparoscopic dismembered Anderson-Hynes pyeloplasty is safe and effective in the treatment of UPJO in children.The operation method can achieve more favorable cosmetic outcomes than other methods.However,the operation is difficult to perform,so it is necessary to select suitable patients and carry out the operation reasonably on skillful technical basis.