隐匿切口法与传统通道法机器人辅助腹腔镜小儿肾盂成形术的初步比较

Comparison of hidden incision endoscopic surgery and traditional port placement for robotic assisted laparoscopic pyeloplasty in children with ureteropelvic junction obstruction

目的:探讨隐匿切口法与传统通道法机器人辅助肾盂成形术治疗小儿肾积水的安全性和可行性的初步经验。方法:收集于2017年3月21日~2017年6月30日收治的37例小儿肾积水患儿资料,其中传统通道法机器人辅助腹腔镜手术15例(传统通道法),隐匿切口法机器人辅助腹腔镜手术22例(隐匿切口法),比较两组在手术时间、术中估计出血量、术后并发症、留置引流管、术后恢复饮食时间、术后住院天数、手术成功率等方面的差别。结果:两组手术均获得成功,两组在手术时间、估计出血量、术后并发症、留置引流管及住院时间等方面没有差异(P>0.05)。传统通道法术后并发症ClavienⅠ~Ⅱ级发生率40.0%,隐匿切口法术后并发症ClavienⅠ~Ⅱ级发生率27.3%,两组差异有统计学意义(P<0.05)。术后美容效果隐匿切口法比传统通道法要好。结论:传统通道法与隐匿切口法机器人辅助腹腔镜肾盂成形术治疗婴幼儿肾积水安全可行,术中和术后并发症少。隐匿切口法机器人辅助腹腔镜肾盂成形术具有操作空间大、美容效果好等优点,推荐在机器人辅助腹腔镜小儿肾盂成形术中使用。

Objective:To compare the efficacy and safety of hidden incision endoscopic surgery(HIdES)vs.traditional port placement(TPP)for robot-assisted laparoscopic pyeloplasty(RALP)in children ureteropelvic junction obstruction.Methods:The clinical data of 37 children who underwent RALP between 21 March 2017 and30 June 2017 were reviewed.TPP for RALP was performed on 15 cases(TPP group),and HIdES for RALP was performed on 22 cases(HIdES group).We assessed preoperative clinical data and outcomes,and analyzed the transition experience.Data were expressed as medians for continuous variables.Results:All operations were successful with no serious intraoperative complication.There were no significant differences in demographics and clinical presentation between two groups(P>0.05).There were no significant differences in operative time,drain removal,start of oral feeding and hospital stay between HIdES group and TPP group(P>0.05).However,there was significant difference in ClavienⅠandⅡcomplications postoperatively between HIdES group and TPP group(P<0.05),and the cosmetic result of HIdES group was better than that of TPP group.Conclusions:HIdES and TPP for RALP in children with UPJO are safe and efficient procedures with equivalent success rate.However,HIdES for RALP may have the advantages of convenient operation and cosmetic result.We propose that HIdES for RALP is potentially a recommended feasible treatment option for children with UPJO.