机器人辅助腹腔镜下肾盂成形术治疗儿童肾盂输尿管连接部梗阻31例

Robot-assisted pyeloplasty for pelvic ureteral junction obstruction in children in 31 cases

目的:探讨机器人辅助腹腔镜下肾盂成形术(robot-assisted laparoscopic pyeloplasty,RALP)治疗儿童肾盂输尿管连接部梗阻(ureteropelvic junction obstruction,UPJO)的临床应用效果。方法:回顾性分析2021年9月—2022年5月在宁夏医科大学总医院接受RALP的31例UPJO患儿,其中男22例,女9例;年龄(57.35±47.10)个月;左侧23例,右侧8例;体重(20.77±12.20)kg。收集手术时间、术中估计出血量、术后引流时间、术后住院时间等临床资料,肾盂前后径(anteroposterior diameter,APD)、肾盂与肾实质厚度比值(pelvis/cortex ratio,PCR)、分肾功能(differential renal function,DRF)等影像学资料。采用第四代DaVinci Xi机器人操作系统,重建肾盂输尿管连接部。结果:31例患儿手术均顺利完成,无中转开放手术病例。平均手术时间为(119.87±15.64)min,平均肾盂输尿管吻合时间(33.65±7.45)min,术中估计出血量<10 mL,术后平均引流时间(6.00±2.49)d,术后平均住院时间(7.13±1.59)d。术后6个月APD较术前及术后3个月明显缩小(P<0.001);PCR较术前及术后3个月明显减小(P<0.001);DRF相比术前明显增加(P<0.001)。4例(12.9%)患儿出现短期并发症,无再梗阻行二次手术病例。结论:RALP可以安全、有效地在UPJO患儿中应用,若能进一步控制费用和突破技术,值得推广作为一线选择。

Objective To investigate the clinical application of robot-assisted laparoscopic pyeloplasty(RALP)in the treatment of ureteropelvic junction obstruction(UPJO)in children.Methods We retrospectively analysed 31 children with UPJO who underwent RALP in our hospital from September 2021 to May 2022,including 22 males and 9 females,23 left-sided and 8 right-sided,whose age was(57.35±47.10)months and weight was(20.77±12.20)kg.Clinical data such as operation time,estimated intraoperative bleeding,postoperative drainage time,postoperative hospitalization time were collected.Anteroposterior diameter(APD),pelvis;cortex ratio(PCR),differential renal function(DRF),and other imaging data were collected.The fourth-generation DaVinci Xi robotic operating system was used to reconstruct the pelvic ureteral junction.Results All 31 children were operated successfully without conversion to open surgery.Operative time was(119.87±15.64)min,and pelvic ureteral anastomosis time was(33.65±7.45)min,intraoperative estimated bleeding was<10 mL,and postoperative drainage time was(6.00±2.49)d,postoperative hospital stay(7.13±1.59)d.APD was significantly smaller at 6 months postoperatively compared with preoperative and 3 months postoperatively(P<0.001).Four(12.9%)children had short-term complications,but there were no cases who needed secondary surgery because of re-obstruction.Conclusion RALP can be used safely and effectively in children with UPJO,so it is worth promoting as a first-line option after further improvements in cost control and technique breakthrough.