机器人辅助腹腔镜肾盂成形术在儿童肾盂输尿管连接部梗阻中的应用

Application of Robot-assisted Laparoscopic Pyeloplasty for Ureteropelvic Junction Obstruction in Children

目的探讨机器人辅助腹腔镜肾盂成形术(robot-assisted laparoscopic pyeloplasty,RALP)治疗儿童肾盂输尿管连接部梗阻(ureteropelvic junction obstruction,UPJO)的效果。方法回顾性分析2020年11月~2021年11月47例儿童UPJO行RALP的临床资料。年龄1岁2个月~13岁4个月,中位年龄48个月。术前肾盂前后径(anterior-posterior renal pelvic diameter,APD)21~56 mm,(39.7±8.8)mm,利尿性肾核素显像提示患肾分肾功能比例23%~39%,(34.0±3.9)%。使用da Vinci Xi机器人操作系统,机器人剪刀修剪肾盂及输尿管,5-0单股薇乔线连续缝合吻合肾盂输尿管。结果47例RALP均顺利完成,无中转开放,术中无并发症。手术时间110~220 min,(170.4±27.4)min,其中肾盂输尿管吻合时间35~60 min,(44.7±7.3)min,术中出血量均<15 ml。1例拔除双J管后吻合口梗阻,再次手术。余46例拔除双J管6个月复查泌尿系统超声,APD(26.8±7.8)mm,较术前(40.0±8.7)mm明显缩小(配对t检验,t=53.583,P=0.000),利尿性肾核素显像均提示无梗阻,患肾分肾功能(46.8±3.8)%,较术前(34.0±4.0)%明显提高(配对t检验,t=-51.913,P=0.000)。结论RALP治疗1岁以上儿童UPJO安全、有效。

Objective To investigate the effect of robot-assisted laparoscopic pyeloplasty(RALP)in the treatment of ureteropelvic junction obstruction(UPJO)in children.Methods Clinical data of 47 children with UPJO who underwent RALP from November 2020 to November 2021 were retrospectively analyzed.The age ranged from 1 to 13 years old,with a median of 48 months old.The preoperative anterior-posterior renal pelvic diameter(APD)was 21-56 mm[mean,(39.7±8.8)mm],and the differential renal function of affected kidneys was 23%-39%[mean,(34.0±3.9)%],indicated by the diuretic renal dynamic imaging(DRDI).Using the da Vinci Xi robotic operating system,robotic scissors were utilized to trim the renal pelvis and ureter,and a 5-0 single-strand Vicryl suture was applied for anastomosis of the renal pelvis and ureter.Results All the 47 cases of RALP were successfully completed without conversion to open surgery or intraoperative complications.The operation time was 110-220 min[mean,(170.4±27.4)min],of which the ureteropelvic anastomosis time was 35-60 min[mean,(44.7±7.3)min],and the intraoperative blood loss was less than 15 ml.One case suffered from anastomotic obstruction after the double-J tube was removed and underwent operation again.The remaining 46 cases were re-examined by ultrasonography of the urinary system at 6 months after double-J tube removal.The APD was(26.8±7.8)mm,which was significantly smaller than(40.0±8.7)mm pre-operation(paired t test,t=53.583,P=0.000).The re-examination of DRDI at 6 months post-operation showed no obstruction,and the differential renal function of the affected kidney was(46.8±3.8)%,which was significantly improved than(34.0±4.0)%pre-operation(paired t test,t=-51.913,P=0.000).Conclusion RALP is safe and effective for the treatment of UPJO in children older than 1 year old.