达芬奇机器人辅助腹腔镜手术治疗儿童复发性肾盂输尿管连接处狭窄

Robot-assisted laparoscopic pyeloplasty for recurrent ureteropelvic junction obstruction in children

目的探讨达芬奇机器人辅助腹腔镜下肾盂输尿管整形术治疗儿童复发性肾盂输尿管连接处狭窄的安全性和有效性。方法收集2016年11月至2021年2月在中山大学附属第一医院就诊的9例复发性肾盂输尿管连接处狭窄患儿的临床资料,其中男7例,女2例,左侧7例,右侧2例,年龄(8.4±3.7)岁(4~15岁),体重(28.24±15.58)kg,均采用达芬奇机器人辅助腹腔镜下肾盂输尿管整形术进行治疗,收集患儿围手术期的临床资料进行分析。手术指征为:(1)反复出现腹痛、泌尿系感染,经过正规标准抗感染治疗后仍反复发作;(2)随访过程中影像学检查提示肾积水进行性加重;(3)随访过程中核素肾图检查提示尿路存在机械性梗阻且患侧分肾功能下降超过5%。结果所有患儿均顺利完成手术,无中转开放手术,无需术中术后输血。手术时间(231.8±73.1)min,游离肾盂输尿管时间(91.9±30.4)min,肾盂输尿管吻合时间(36.6±7.2)min,出血量(14.0±10.3)ml,术后住院天数(7.7±4.6)d,随访时间为(37.0±18.8)个月。1例患儿术后出现并发症,为Clavien-Dindo分类2级。拔除双J管后复查症状消失,肾积水均有改善。结论达芬奇机器人辅助腹腔镜下肾盂输尿管整形术可安全有效地应用于儿童复发性肾盂输尿管连接处狭窄。

Objective To explore the safety and efficacy of robot-assisted laparoscopic pyeloplasty(RALP)for recurrent ureteropelvic junction obstruction(UPJO)in children.Methods From November 2016 to February 2021,retrospective review was conducted for 9 children with recurrent UPJO after pyeloplasty.During RALP,peri-operative data were collected.The indications of reoperation included recurrent symptoms such as abdominal pain and urinary tract infection after standardized anti-infection treatment.Hydronephrosis worsened during follow-ups.Obstructive scintigraphy hinted at a deterioration of differential renal function>5%.Successful reconstruction was defined as resolution of symptoms,resolved or improved hydronephrosis and there was no need for additional procedures.Results All operations were completed without any conversion into open surgery or blood transfusion.Mean total operative time was(231.8±73.1)min,mean dissection time to ureteropelvic junction(91.9±30.4)min,mean anastomotic time(36.6±7.2)min,mean blood loss(14.0±10.3)ml,mean postoperative hospital time(7.7±4.6)days and mean follow-up period(37.0±18.8)months.Only one child had a complication of Clavien-Dindo classification II.All symptoms disappeared and hydronephrosis improved with a removal of D-J stent.Conclusions RALP is both safe and effective for recurrent UPJO in children.