腹腔镜辅助肾盂成形术治疗婴幼儿肾盂输尿管交界部梗阻的经验分析

Experience analysis of laparoscopic-assisted pyeloplasty in the treatment of ureteropelvic junction obstruction in infants

目的:分析腹腔镜辅助肾盂成形术治疗婴幼儿重度肾积水的可行性、安全性及初步经验。方法:2015年10月至2017年5月为34例重度肾积水患儿经脐上、下缘及肾盂输尿管交界部腹部体表投影水平向外1~2 cm处三个切口穿刺Trocar进行手术治疗,腹腔内游离肾盂输尿管交接部,后经腹部切口提出交接部行腹腔外肾盂输尿管成形术。结果:34例手术均获成功,无另加套管及中转开放手术,手术时间平均(79.8±30.3)min,术中出血量平均(2.9±1.9)mL,术后平均住院(6.9±2.1)d。术后随访6~24个月,21例形态接近正常,13例肾盂分离1.0~1.5 cm,腹部瘢痕不明显。结论:腹腔镜辅助肾盂成形术治疗婴幼儿重度肾积水手术效果肯定,手术操作及术后护理简单,容易被掌握,具有较好的美容效果,值得推广。

Objective:To investigate the feasibility,safety and preliminary experience of laparoscopy-assisted pyeloplasty in the treatment of severe hydronephrosis in infants.Methods:From Oct.2015 to May 2017,34 infants of severe hydronephrosis were operated through the upper and lower margin of the umbilicus and the outward 1-2 cm incision in abdominal surface projection of ureteropelvic junction.The ureteropelvic junction was dissected in abdominal cavity,and it was taken outside of the abdominal cavity through the abdominal incision,then pyeloureteroplasty was performed.Results:This operation was successful in all 34 cases without additional Trocar or conversion to laparotomy.The average operation time was(79.8±30.3)min;The average intraoperative blood was(2.9±1.9)mL,and the average hospital stay was(6.9±2.1)d.During the follow-up of 6-24 months,the morphology of 21 cases was close to normal,13 cases had renal pelvis separation of 1.0-1.5 cm,and the abdominal scar was not obvious.Conclusions:Laparoscopy-assisted pyeloplasty in the treatment of infants with severe hydronephrosis has the advantages of definite effect,easy operation,simple postoperative nursing,and good cosmetic effect,so it is worth popularizing.