机器人辅助腹腔镜技术治疗3例儿童完全性重复肾合并输尿管开口异位并文献复习

Application of robot-assisted laparoscopic end-to-side ureteroureterostomy for complete duplex kidneys with ureteral ectopia in children:a report of three cases with a literature review

目的初步探讨机器人辅助腹腔镜输尿管端侧吻合在儿童完全性重复肾合并输尿管开口异位中的应用。方法回顾性分析2016年6月至2020年7月收治的3例完全性重复肾合并上组肾输尿管开口异位患儿采用机器人辅助腹腔镜技术治疗的临床资料。3例患儿性别女,表现为尿失禁(正常排尿间歇滴尿);平均年龄为40个月;2例患儿患病部位为左侧,1例患儿患病部位为右侧;术中均采用输尿管端侧吻合,术中双J管置于下组肾输尿管内。以"机器人(robotic)""输尿管端侧吻合(ureteroureterostomy)""儿童(pediatric)"为关键词检索2007年1月至2022年2月发表的PubMed及万方、中国知网数据库的相关文献并进行文献复习。结果本组3例术中无中转开放;患儿腹腔内操作时间分别为181、126、87 min,吻合时间分别为57、47、32 min,术后住院时间分别为6、4、1 d。术后6~8周拔除双J管。术后随访时间分别为60、50、26个月,术后尿失禁症状消失,输尿管扩张较术前明显缓解甚至消失。共检索到15篇共204例患儿涉及机器人辅助腹腔镜输尿管端侧吻合在儿童完全性重复肾合并相关畸形中应用,其中明确合并输尿管开口异位的患儿共78例,术后预后良好。结论机器人辅助腹腔镜输尿管端侧吻合术可安全、有效地应用于儿童完全性重复肾合并输尿管开口异位的治疗。

Objective To explore the value of robot-assisted laparoscopic end-to-side ureteroureterostomy(RAL-UU)for duplex kidneys with ureteral ectopia in children.Methods Retrospective analyses were performed for clinical data of 3 girls with complete duplex kidneys with upper pole ureteral ectopia undergoing robot-assisted laparoscopic end-to-side ureteroureterostomy from June 2016 to July 2020.All of them had a complaint of incontinence.Mean age was 40 months.The involved side was left(n=2)and right(n=1).DJ tube was implanted in lower pole ureter.A systematic review of literature was performed by searching the databases of PubMed,CNKI and WanFang from January 2007 to February 2022,including MeSH terms of robotic and robot-assisted laparoscopy.Results There was no intraoperative conversion to open surgery.Intraperitoneal operative durations were 181,126,87 min,anastomotic times 57,47,32 min and postoperative hospital stay 6,4,1 days.DJ tube was removed at(6-8)weeks post-operation and postoperative follow-up period were 60,50,26 months.The symptoms of postoperative urinary incontinence disappeared and ureteral dilation became greatly relieved or even disappeared as compared with pre-operation.A total of 15 articles involving 204 children were included for outcome assessments of pediatric RAL-UU.And 78 of them had a definite ectopic ureteral orifice.Postoperative prognosis was generally decent.Conclusions RAL-UU may be safely and effectively performed for duplex kidneys with ureteral ectopia in children.