经结肠旁沟入路机器人辅助腹腔镜肾盂成形术治疗儿童肾积水的操作体会及疗效分析

Operation experience and effect analysis of robotic-assisted laparoscopic pyeloplasty for hydronephrosis in children through retrocolic approach

目的:探讨经结肠旁沟入路机器人辅助腹腔镜肾盂成形术治疗儿童肾积水的手术技巧、临床疗效及价值应用。方法:回顾性分析2020年9月-2022年4月南通大学附属医院小儿外科收治的20例肾积水患儿,其中男16例,女4例;年龄1~11岁,平均6岁8个月;左侧16例,右侧4例。20例患儿均采用经结肠旁沟入路进行手术,健侧卧位70°。观察手术时间、术中出血量、术后住院时间、术后并发症、成功率、术后随访情况等。结果 :20例患儿均顺利完成手术,无中转开放。其中单纯狭窄扭曲导致输尿管肾盂连接部梗阻12例(1例为术后再狭窄),肾盂输尿管连接处息肉3例,腔静脉后输尿管1例,高位输尿管2例,迷走血管压迫2例。手术时间80~150 min,平均105 min,术中出血量3~10 mL,术后住院时间7~10 d。术中无肠管损伤,术后无吻合口狭窄、吻合口瘘等并发症。术后随访1~12个月,平均8个月,术后肾盂前后径为(1.33±0.28) cm,较术前(2.74±0.70) cm明显好转(P<0.05)。结论:经结肠旁沟入路机器人辅助腹腔镜肾盂成形术安全、有效,该入路有利于处理各种病因导致的肾积水,尤其对在非大型儿童中心和综合性医院达芬奇系统的初学者,具有学习曲线短、术野易暴露、操作易掌握等优点,值得临床推广。

Objective: To explore the operative skill and clinical application study of robotic-assisted laparoscopic pyeloplasty(RALP) for hydronephrosis in children through retrocolic approach. Methods: A total of 20 patients(16 males, 4 females) diagnosed with hydronephrosis were retrospectively analyzed from September 2020 to April 2022. All of 20 patients with a median age of6 years and 8 months old(range from 1 to 11 years old) were theated with RALP through retrocolic approach, that 16 cases were on the left side and 4 cases on the right side. The 20 patients were placed in the healthy lateral decubitus position at 70 degrees.Finally, the time of operation, the intraoperative blood loss, the postoperative hospital stay, complications, the rate of success and follow-up outcomes were analyzed. Results: All the cases have been performed successfully without a transit open surgery containing pure ureteropelvic junction obstruction(n=12, one was postoperative restenosis), fibroepithelial polyps(n=3), postcaval ureter(n=1) and high ureter(n=2) compression of vagal vessels(n=2) depending on the operative exploration. The operative time was 80-150 min with the average of 105 min, intraoperative the blood loss was 3-10 mL and postoperative hospital stay was7-10 d. There were no intraoperative or postoperative complication scontaining injury of bowel, anastomotic stenosis and anastomotic leakage. A regular follow-up period was 1-12 months with the average of 8 months. There was a significant difference between the mean postoperative value of anteroposterior diameter(APD)(1.33±0.28) cm and the mean preoperative value of APD(2.74±0.70) cm. Conclusions: RALP through retrocolic approach were safe, feasible and effective. The method holds the advantages such as simple operation, good exposure of surgical field, easy to master and short learning curve especially for the beginners of the Da Vinci system in non-large children′s centers and general hospitals, which is worthy of clinical promotion.