摘要
目的:探讨机器人辅助腹腔镜手术治疗儿童重复肾输尿管畸形,分析在不同类型畸形个性化手术中的临床疗效及安全性。方法:回顾性分析2021年1月—2024年8月贵州省人民医院小儿外科收治的21例重复肾输尿管畸形患儿的临床资料。其中男10例,女11例,平均年龄(58.95±52.83)个月,平均体重(18.76±13.73)kg;左侧12例,右侧8例,双侧1例;完全型重复肾16例,不完全型重复肾5例。所有患儿均接受机器人辅助腹腔镜微创手术,根据不同病情制定了不同术式。重复半肾及附属输尿管切除术14例,重复肾输尿管-输尿管吻合2例,肾盂-输尿管吻合术2例,输尿管膀胱再植1例,患侧发育不良肾脏及输尿管切除术2例。结果:21例患儿均在机器人辅助腹腔镜下成功完成手术,无中转行传统腹腔镜及开放手术,无术中、术后严重并发症发生。平均手术时间(261.43±82.40)min,术中平均出血量(17.62±21.48)mL,术后平均住院时间(6.00±2.90)d,术后平均留置引流管时间(4.00±2.76)d,术后平均留置尿管时间(3.14±2.52)d。3例尿失禁患儿术后拔除尿管后未再出现漏尿症状;1例腰痛及3例腹痛患儿术后均未再出现腰腹部疼痛不适;2例术前反复泌尿道感染患儿术后随访未再出现泌尿道感染症状。所有病例均无大出血、吻合口狭窄、尿瘘、输尿管残端综合征等严重并发症发生。结论:机器人辅助腹腔镜手术治疗儿童重复肾输尿管畸形是安全可行的,对于不同重复肾输尿管畸形病例需根据患儿重复肾类型、临床表现、术前影像学检查同时结合术中探查情况采取个性化手术方案。
Objective:To explore robot-assisted laparoscopic surgery for children with duplex kidneys and ureters,and to analyze the clinical efficacy and safety in personalized surgeries for different types of malformations.Methods:The clinical data of 21children with duplicated renal ureteral malformation admitted to the Department of Pediatric Surgery of Guizhou Provincial People’s Hospital between January 2021and August 2024were collected.Among them,10males and 11females.The average age was(58.95±52.83)months,and the average weight was(18.76±13.73)kg;12cases were left-sided,8cases were right-sided and 1case was bilateral;16cases were complete duplicate kidneys and 5cases were incomplete duplicate kidneys.All the children underwent minimally invasive robot-assisted laparoscopic surgery,and different surgical procedures were developed according to different conditions.There were 14cases of duplicated heminephrectomy and ureter resection,2cases of duplicated kidney ureter-ureter anastomosis,2cases of renal pelvis-ureter anastomosis,1case of ureteral bladder reimplantation,and 2cases of resection of a dysplastic kidney and ureter on the affected side.Results:All the 21children completed the operation by robot-assisted laparoscopy without conversion to traditional laparoscopy or open surgery.No serious complications occurred during and after operation.The average operation time was(261.43±82.40)min,and the average intraoperative blood loss was(17.62±21.48)mL.The average postoperative hospital stay was(6.00±2.90)d,and the postoperative drainage tube removal time was(4.00±2.76)d.The postoperative·951·urinary catheter removal time was(3.14±2.52)d.Three children with urinary incontinence did not have urinary leakage symptoms after removal of urinary catheter after operation.One child with low back pain and three children with abdominal pain did not suffer from low back pain or discomfort after operation.Two children with recurrent urinary tract infection before operation did not have any symptoms of urinary tract infection after operation.No serious complications such as massive bleeding,anastomotic stenosis,urinary fistula or ureteral stump syndrome occurred in all cases.Conclusion:Robot-assisted laparoscopy surgery is safe and feasible to treat children with duplex kidney.For different cases of duplex kidney,individualized surgical plan should be adopted according to the type of duplex kidney,clinical manifestations,preoperative imaging examination and intraoperative exploration.
作者
王蔚
朱国华
占雄
吴谋东
彭金普
安妮妮
WANG Wei;ZHU Guohua;ZHAN Xiong;WU Moudong;PENG Jinpu;AN Nini(Department of Pediatric Surgery,Guizhou Provincial People’s Hospital,Guiyang,Guizhou,550002,China;Department of Pediatric Urology,Guizhou Hospital of Shanghai Children’s Medical Center)
出处
《临床泌尿外科杂志》
2025年第11期951-956,961,共7页
Journal of Clinical Urology
基金
2025年贵州省卫生健康委省级医学重点学科建设项目经费资助。
