摘要
目的探讨达芬奇机器人单孔加一孔技术在儿童常见泌尿系统手术应用中的有效性和安全性。方法回顾性分析2022年5月至2023年11月福州大学附属省立医院小儿外科行单孔加一孔机器人辅助腹腔镜手术的59例患儿的临床资料。男44例,女15例;中位年龄36(6,108)个月。其中肾盂输尿管连接处狭窄27例,术前肾盂前后径(31.83±6.59)mm;美国胎儿泌尿外科协会(SFU)分级Ⅲ级8侧,Ⅳ级19侧;双侧分肾功能差值中位值13.50%(7.18%,31.06%)。膀胱输尿管反流17例,术前排泄性膀胱尿道造影(VCUG)提示膀胱输尿管反流Ⅲ级8侧,Ⅳ级14侧,Ⅴ级4侧;双侧分肾功能差值中位值18.58%(6.04%,28.30%)。梗阻性巨输尿管10例,术前肾盂前后径(22.17±7.64)mm,输尿管最大直径(19.51±3.71)mm,术前双侧分肾功能差值中位值18.02%(5.23%,49.42%)。重复肾输尿管5例,泌尿系磁共振水成像(MRU)提示均为单侧重复肾,重复上肾盂、肾盏伴输尿管重度扩张积水,肾皮质菲薄;其中2例合并输尿管异位开口,1例合并输尿管末端囊肿。肾盂输尿管连接处狭窄患儿行肾盂输尿管离断成形术,膀胱输尿管反流和梗阻性巨输尿管患儿均行输尿管再植术;重复肾输尿管患儿行重复肾切除术。所有患儿均使用达芬奇机器人Xi系统,布孔方式均采用绕脐部取一长2~3 cm的手术切口,放入单孔四通道装置,在直视下根据手术部位在左或右腹置入另一个8 mm操作通道。比较手术前后各项参数变化。结果所有手术均顺利完成,未中转开放或腹腔镜手术。肾盂输尿管离断成形术患儿手术时间(141.52±22.93)min,术后肾盂前后径(12.54±4.05)mm,双侧分肾功能差值为5.60%(2.14%,14.48%),均较术前明显改善(P<0.01);术后SFU分级Ⅰ级13侧,Ⅱ级13侧,Ⅲ级1侧,较术前改善。膀胱输尿管反流患儿的手术时间单侧为(125.00±11.75)min,双侧为(153.22±14.39)min;术后VCUG反流级别Ⅰ级2侧,Ⅱ级、Ⅲ级各1侧,余未见反流;术后双侧分肾功能差值13.34%(1.85%,20.54%),较术前下降(P=0.011)。梗阻性巨输尿管患儿的手术时间为(180.89±18.09)min;术后肾盂前后径(10.31±3.86)mm,输尿管最大直径(6.62±2.44)mm,均较术前改善(P<0.01);术后双侧分肾功能差值12.04%(4.85%,47.53%),较术前改善,但差异无统计学意义(P=0.508)。重复肾切除患儿手术时间(140.00±12.75)min,术前症状均未再出现,随访期间患侧残肾皮质功能基本正常。本研究中仅3例梗阻性巨输尿管术后1个月内出现发热性泌尿系感染,余均未见并发症发生。结论本研究初步证实达芬奇机器人单孔加一孔技术可用于儿童泌尿系统常见疾病治疗,患者术后症状较前明显缓解,肾积水各项指标较术前好转,术后并发症发生率不高,术后伤口美容效果较好,后续尚需更多的研究观察其长期疗效。
ObjectiveTo explore the efficacy and safety of the Da Vinci robotic single-port-plus-one technique in common urological surgeries in children.MethodsThe data of 59 children who underwent robot-assisted single-port-plus-one laparoscopic surgery from May 2022 to November 2023 in Fuzhou University Affiliated Provincial Hospital were retrospectively analyzed.There were 44 males and 15 females,aged 36(6,108)months.Among them,27 cases had ureteropelvic junction obstruction,with a preoperative anterior-posterior diameter of the renal pelvis of(31.83±6.59)mm.The American Society of Fetal Urology(SFU)grading system revealed gradeⅢin 8 sides and gradeⅣin 19 sides.Bilateral renal function showed a difference of 13.50%(7.18%,31.06%).Additionally,17 cases presented with vesicoureteral reflux.Preoperative voiding cystourethrogram(VCUG)indicated reflux gradesⅢ,Ⅳ,andⅤin 8,14,and 4 sides,respectively,with a difference in bilateral renal function of 18.58%(6.04%,28.30%).Ten cases had obstructive megaureter,with a preoperative renal pelvis diameter of(22.17±7.64)mm and a maximum ureteral diameter of(19.51±3.71)mm.The preoperative bilateral renal function difference was 18.02%(5.23%,49.42%).Five cases involved duplicated kidney and ureter.Magnetic resonance urography(MRU)confirmed unilateral duplicated kidneys with associated dilatation of the upper renal pelvis and calyces,hydroureter,thin renal cortex in all 5 patients.Among them,2 cases had ectopic ureteral opening and 1 case had terminal ureteral cyst.Patients with ureteropelvic junction stenosis underwent pyeloplasty,those with vesicoureteral reflux and obstructive megaureter underwent ureteral reimplantation,and patients with duplicated ureters underwent nephrectomy.The Da Vinci robotic surgical system was employed for all procedures.The port placement technique involved a 2-3 cm incision around the navel to insert a single-port four-channel device,followed by the placement of an additional 8 mm operating channel in the left or right abdomen under direct visualization based on the surgical site.Preoperative and postoperative parameters were compared.ResultsAll operations were successfully completed without conversion to open or laparoscopic surgery.The operation time of the ureteropelvic junction obstruction children was(141.52±22.93)min.The postoperative renal pelvis diameter and bilateral renal function difference were(12.54±4.05)mm and 5.60%(2.14%,14.48%),respectively,both of which showed significant improvement compared to preoperative levels(P<0.01).Postoperative hydronephrosis grades were as follows:13 sides with gradeⅠ,13 sides with gradeⅡ,and 1 side with gradeⅢ.The operation time of vesicoureteral reflux children was(125.00±11.75)min in the unilateral group and(153.22±14.39)min in the bilateral group.Postoperatively,2 sides demonstrated reflux gradeⅠ,1 side gradeⅡ,and 1 side gradeⅢ,indicating improvement compared to preoperative levels.Bilateral renal function difference post-surgery was 13.34%(1.85%,20.54%),which was more balanced than preoperatively(P=0.011).Postoperative renal pelvis anterior-posterior diameter and maximum ureteral diameter were reduced to(10.31±3.86)mm and(6.62±2.44)mm,respectively,which were significantly smaller than preoperative measurements(P<0.01).The bilateral renal function difference post-surgery was 12.04%(4.85%,47.53%),showing improvement,though not statistically significant(P=0.508).The operation time of the repeated nephrectomy children was(140.00±12.75)min.No recurrence of preoperative symptoms was noted,and renal cortical function remained generally normal during follow-up.In this study,only 3 cases of obstructive megaureter developed febrile urinary tract infection within 1 month after surgery,and no complications were observed in the remaining cases.ConclusionsThis study preliminarily confirmed that the Da Vinci robotic single-port-plus one-port technology can be used in the treatment of common diseases of the urinary system in children.The patients'symptoms were significantly relieved after surgery,and the indicators of hydronephrosis improved compared with those before surgery.The incidence of postoperative complications was low,and aesthetic outcomes of postoperative scars were enhanced.Further studies are needed to assess its long-term efficacy.
作者
张玉茹
陈江龙
林珊
汤坤彬
何玉锋
尤光旭
徐迪
Zhang Yuru;Chen Jianglong;Lin Shan;Tang Kunbin;He Yufeng;You Guangxu;Xu Di(Shengli Clinical Medical College of Fujian Medical University,Pediatric Department of Fuzhou University Affiliated Provincial Hospital,Fuzhou 350001,China)
出处
《中华泌尿外科杂志》
北大核心
2025年第3期213-218,共6页
Chinese Journal of Urology
基金
福建省省级临床重点专科建设项目(闽财指[2024]43号)
