达芬奇机器人辅助手术治疗儿童输尿管上段纤维上皮息肉

Robotic-assisted laparoscopy for upper ureteral fibroepithelial polyps

目的总结达芬奇机器人辅助手术治疗儿童输尿管纤维上皮性息肉的初步经验,并对处理方法进行探讨。方法回顾性分析中山大学附属第一医院小儿外科2016年11月到2019年7月采用达芬奇机器人手术治疗4例输尿管纤维上皮性息肉患儿的临床资料。其中,男3例,女1例;平均年龄9.3岁;息肉位于左侧输尿管3例,右侧输尿管1例。2例患儿因为侧腹部疼痛就诊被发现;另2例因产前诊断肾积水,随访过程中积水加重而手术治疗。3例患儿术前行MRI检查,1例行CT检查,2例术前行磁共振泌尿系统水成像(MR urography,MRU)检查得到诊断。结果所有患儿息肉均位于输尿管上段,均为多发,例1为宽基底,其余3例均为带蒂多指状;息肉长度5~30 mm,平均长度为20 mm;术后病理检查均提示输尿管纤维上皮性息肉。所有患儿拔除双J管后1个月复查泌尿系统B型超声检查提示患儿肾盂前后径平均值为19.0 mm,较术前47.3 mm明显改善,且差异有统计学意义(P<0.05)。本组随访时间4个月至3年,平均1年3个月,至今无近、远期并发症出现。结论达芬奇机器人辅助离断式肾盂输尿管整形术治疗儿童输尿管上段息肉是一个安全、有效的手段,术后外观满意。

Objective To summarize our institutional experiences of robot-assisted laparoscopy(RAL)for upper ureteral fibroepithelial polyps(UFP).Methods A retrospective study was conducted for 4 UFP cases undergoing RAL from November 2016 to July 2019.There were 3 boys and 1 girl with a mean age of 9.3 years.The side of obstruction was left(n=3)and right(n=1).Two patients presented with flank pain while another two of prenatal hydronephrosis worsened during follow-ups.Preoperative evaluations were performed by MR urogram(n=3)and CT(n=1).Two patients were diagnosed preoperatively by MR urography.Results Four children underwent RAL for upper UFP.The polyps were broad-based(n=1)and multifinger pedunculated(n=3).The average length was 20(5-30)mm.Histopathologic examination revealed fibroepithelial polyps(FEPs).Hydronephrosis had an average anteroposterior diameter of 19 mm on ultrasound at 1 month after removing double-J stent.And there was a marked improvement over a preoperative value of 47.3 mm(P<0.05).During an average follow-up period of 15(4-36)months,there was no short-long-term complication.Conclusions With an excellent cosmetic outcome,RAL is both safe and effective for children with upper ureteral fibroepithelial polyps.