10例机器人辅助下腹腔镜小儿肾盂输尿管成型术的手术配合

目的总结机器人辅助下腹腔镜小儿肾盂输尿管成型术的护理经验。方法回顾性分析10例肾积水患儿在机器人辅助下经腹腔镜行肾盂输尿管成形术的手术配合情况,包括完善的术前准备、手术间布局、合理的体位安置、穿刺点定位、术中仪器设备连接、患儿体温管理以及高值耗材的管理等。结果 10例患儿均顺利完成手术,手术时间90~130min,术后无一例患儿发生感染、输尿管狭窄等并发症,肾功能均有不同程度恢复。结论充分的术前准备工作、正确的体位摆放、合理的手术间布局、有效的体温管理、熟练的机器人操作配合是确保手术顺利进行的关键。     

后腹腔镜下腔静脉后输尿管成形术患者的护理

目的探讨腹腔镜腔静脉后输尿管成形术的护理要点。方法对8例腔静脉后输尿管的患者进行了腹腔镜腔静脉后输尿管成形术,分析总结患者的术前准备、术后护理及出院的情况。结果所有手术均取得成功,术中无并发症,患者均治愈出院。随访3个月,超声、IVP检查示无输尿管狭窄、肾积水较前减轻或者消失。结论结合腹腔镜的护理,术前对患者的心理及生理方面进行充分的准备、术后做好患者的饮食、饮水、活动、相关并发症的观察及出院指导是保证手术效果的关键。     

小儿机器人肾盂成形术的经验初探

目的:探讨机器人小儿肾盂成形术的有效性、安全性及病例的选择,总结初步经验。方法:回顾分析2020年8~9月为3例肾盂输尿管连接部梗阻所致的肾盂积水患儿行机器人手术的临床资料,患儿均为男性,分别为4.5岁、7.2岁、5.8岁,术前均经磁共振泌尿系水成像检查诊断为肾盂输尿管连接部梗阻所致的肾盂积水,患侧均为左侧,术前肾盂前后径分别为3.2 cm、2.7 cm、2.2 cm。统计分析手术时间、术中估计出血量、术后并发症、留置引流管时间、术后住院时间等相关指标,术后B超随访肾盂积水程度的变化。结果:3例手术均获成功,无中转传统腹腔镜或开放手术,无术中并发症发生。手术时间分别为143 min、95 min、115 min,吻合时间为58 min、30 min、43 min,估计术中出血量为10 mL、5 mL、10 mL。病例2于术后第1天出现血尿,经保守治疗于术后第3天缓解,另2例术后无其他并发症发生。术后分别住院7 d、6 d、8 d。3例患儿术后均取出双J管,随访肾盂前后径分别为2.0 cm、1.8 cm、1.8 cm。结论:机器人肾盂成形术治疗小儿肾盂输尿管连接部梗阻安全、有效,术中、术后并发症少,其最大优势在于降低术中缝合难度。     

机器人辅助腹腔镜小儿肾盂成形术的护理模式探讨

目的:总结机器人辅助腹腔镜小儿肾盂成形术的护理流程,探讨机器人小儿泌尿手术的围手术期模式.方法:回顾性分析2014年5月～2017年7月于海军军医大学第一附属医院行机器人辅助腹腔镜肾盂成形术的26例患儿(男23例,女3例)的围手术期资料和护理管理情况,包括患者基本资料、手术时间、术中出血、术后住院时间和术后并发症等.结果:26例患儿机器人辅助腹腔镜手术均经腹腔顺利完成,无中转开腹手术,患儿年龄为(6.69±3.35)岁,手术时间为(183.19±81.463)min,术中出血量为(9.62±5.643)ml.术后平均住院时间为(4.85±?1.056)d.机器人摆放就位时间由30min缩短为15min,术后未发生任何因护理配合不当而出现的并发症.结论:机器人手术系统在小儿泌尿手术中具有创伤小、出血少、疗效好等优点.在机器人手术中护理人员应充分完善护理准备、提升护理配合质量、总结经验,确保形成系统、有效的可行护理管理模式.     

机器人辅助腹腔镜下婴幼儿肾盂输尿管成形术的护理配合

目的:总结机器人辅助腹腔镜下婴幼儿肾盂输尿管成形术的手术室护理配合经验,进一步优化、细化手术配合流程,为该手术护理流程标准化提供借鉴.方法:回顾性分析2016年3月21日～2018年3月21日175例患者在中国人民解放军总医院第七医学中心行机器人辅助腹腔镜下婴幼儿肾盂输尿管成形术的手术配合情况.?结果:175例患儿手术效果良好,术中均未发生中转开放手术,无手术并发症发生.结论:机器人辅助腹腔镜下婴幼儿肾盂输尿管成形术安全可行,具有视野清晰、操作精准、恢复快、美容效果好等优点.手术室护士的专业化技术培训、完善的术前准备、仪器设备的有效管理、安全合理的手术体位安置是确保手术顺利进行和成功的关键,同时应注意患儿的术中体温及皮肤管理.     

无线腔镜系统应用于肾盂输尿管离断成形术中的疗效分析

目的:探讨应用无线腔镜系统行肾盂输尿管成形术治疗肾盂输尿管连接部梗阻的安全性及近期疗效。方法:回顾分析2019年1月至2021年10月为45例患者行腹腔镜肾盂输尿管成形术的临床资料;其中21例行无线腹腔镜肾盂输尿管成形术(无线组),24例行普通腹腔镜肾盂输尿管成形术(普通组),对比两组手术情况及短期疗效;采用piper疲乏量表对两组手术扶镜者的疲劳度进行评价,对比分析两组手术扶镜者的疲劳度。结果:无线组手术准备时间、扶镜者疲劳度优于普通组,差异有统计学意义(P<0.05);两组手术时间、手术失血量、术后引流管留置时间、术后住院时间及并发症发生率差异无统计学意义。中位随访17.2(5～38)个月,两组患者肾积水症状均明显减轻,术后患侧肾脏平均肾小球滤过率均有明显改善,与术前相比,差异有统计学意义(P<0.05)。结论:相较普通腹腔镜肾盂输尿管成形术,无线腹腔镜肾盂输尿管成形术的手术准备时间更短,可有效减轻扶镜者的疲劳度,术后短期疗效理想,是安全、可靠的治疗方法。     

后腹腔镜下肾盂成形术治疗小儿肾盂输尿管连接处梗阻的效果及安全性

目的探讨腹腔镜下肾盂成形术治疗肾盂输尿管连接处梗阻患儿的效果及安全性。方法随机将62例肾盂输尿管连接处梗阻的患儿分为2组,各31例。对照组采用开放肾盂成形术,观察组采用后腹腔镜下肾盂成形术。结果观察组术中出血量及术后下床活动时间、住院时间均短或少于对照组,差异均有统计学意义(P 0. 05)。结论后腹腔镜下肾盂成形术治疗小儿肾盂输尿管连接处梗阻,可减少术中出血量,促进术后恢复,且安全性高。     

后腹腔镜下肾盂成形术在小儿肾积水手术中的应用

目的总结后腹腔镜下离断式肾盂成形术治疗小儿肾积水的经验。方法2003年12月至2005年9月收治肾积水患儿21例。男15例,女6例,平均年龄6．3岁。左侧14例,右侧7例。B超、IVU、放射性核素肾图检查均提示梗阻位于肾盂输尿管连接处。均采用后腹腔镜下离断式肾盂成形术。结果21例患儿中手术成功19例,中转开放手术2例。手术时间150～230 min,平均185 min。术中平均出血量＜20ml。术后3个月随访B超或放射性核素肾图,肾积水有明显改善。结论后腹腔镜下肾盂成形术有望成为治疗小儿肾积水的可靠方法,远期效果有待进一步随访。     

经脐单孔腹腔镜隐睾下降固定术护理

目的 探讨经脐单孔多通道腹腔镜下隐睾下降固定术治疗小儿隐睾的护理体会。方法 回顾性分析11例行一期隐睾下降固定术。总结其术前心理护理及术后临床护理要点。结果 11例隐睾手术均获得成功,患儿心理状况稳定,术后住院时间3.5±1.1 d。术中、术后均无并发症发生。 结论 完善术前准备、加强心理护理、全麻后护理及术后病情观察是取得手术成功的保障。     

腹腔镜肾盂成形术治疗婴幼儿输尿管肾盂连接部梗阻性肾积水

目的探讨腹腔镜肾盂成形术治疗婴幼儿输尿管肾盂连接部梗阻性肾积水的疗效及安全性。方法回顾性分析2013年12月至2015年12月本院行腹腔镜肾盂成形术治疗的48例婴幼儿输尿管肾盂连接部梗阻性肾积水病例。所有病例连续随访,明确肾积水程度不断加重后行腹腔镜肾盂成形术,术中留置双J管及尿管。结果 48例患儿均手术治疗,1例中转开放手术,平均手术时间105 min,平均出血量7 ml,术后平均住院时间9.5 d;术后随访6~28个月,平均19月,1例于术后2个月取出双J管,其余患儿于术后3~6个月取出双J管;术后复查尿常规、超声及磁共振尿路造影(MRU),无吻合口狭窄;48例患儿中术后泌尿系感染7例,双J管膀胱刺激1例,给予对症治疗后治愈。结论婴幼儿肾积水在产后应密切随访;腹腔镜肾盂成形术在婴幼儿输尿管肾盂连接部梗阻性肾积水的治疗中安全、有效,并发症轻微、可控。     

Delayed decrease in differential renal function after successful pyeloplasty in children with unilateral antenatally detected hydronephrosis

AIM: The aim of this study was to evaluate functional outcome of congenital hydronephrotic kidney. METHODS: The records of consecutive children who underwent pyeloplasty for unilateral prenatally detected ureteropelvic junction obstruction were reviewed. Renal function was assessed renographically before and after surgery. Mean follow-up period was 100 months. RESULTS: Sufficient pre- and postoperative data were available for 60 children. Differential renal function (DRF) improved in 14 (23%) and decreased in nine (15%) of 60 patients in the early postoperative period. DRF improved in seven (18%) and decreased in 13 (34%) of 38 patients at the end of follow-up. Five of 14 patients with increased DRF at early postoperative scan returned to the preoperative level at the end of follow-up. No patients with decreased DRF at early postoperative scan showed any recovery in DRF and progressive decrease was seen in four of nine children. CONCLUSIONS: The DRF was not stable in some patients after successful pyeloplasty. In some patients impairment of renal function came to be apparent with time. Improvement of DRF may be a transient phenomenon seen in the early postoperative period. To avoid overestimation of functional recovery, long-term follow-up with delayed renographic evaluation is recommended.     

The risk factors and clinical significance of acute postoperative complications after unstented pediatric pyeloplasty: A single surgeon’s experience

Purpose

To analyze the risk factors and clinical significance of postoperative complications after unstented pediatric pyeloplasty.

Materials and Methods

We analyzed 285 kidney units (KUs) on which unstented pyeloplasty was performed between April 2002 and March 2010. Measures included preoperative factors, postoperative complications, change in postoperative differential renal function (DRF), and failure of pyeloplasty. Risk factors for acute complications requiring additional ureteral stenting and decreased DRF were analyzed.

Results

During a median follow-up period of 67.0 months, an additional ureteral stenting was required in 28 KUs (9.8%) due to the development of acute postoperative complications after unstented pyeloplasty. The incidence of complications increased significantly as preoperative DRF increased. DRF of more than 60% was the only independent risk factor for acute complications. Postoperative decrease in DRF was observed in 58 KUs (22.4%) among 259 KUs analyzed. Pyeloplasty failure was observed in 10 KUs (3.5%). The development of acute complications was not a risk factor for a decrease in DRF or pyeloplasty failure.

Conclusions

Urinary diversion during pyeloplasty is not related to a decrease in DRF or pyeloplasty failure. However, in patients with a preoperative DRF of greater than 60%, diversion could be considered due to the high prevalence of complications.     

后腹腔镜下行离断性肾盂成形术治疗小儿肾盂输尿管连接部梗阻

目的 观察后腹腔镜下行离断性肾盂成形术治疗小儿肾盂输尿管连接部（UPJ）梗阻的临床疗效.方法 采用经腹膜后径路施行腹腔镜下离断性肾盂成形术治疗小儿UPJ梗阻17例,年龄3～10岁.所有患儿均经影像学检查诊断UPJ梗阻,15例有腰部胀痛或泌尿系统感染史、患侧腹部触及肿块,2例有肾功能减退.结果 17例UPJ梗阻患儿均取得满意的临床疗效.手术时间2.5～6.0h,平均4.3 h,随着经验增加,手术时间缩短.平均出血量38 ml,平均术后住院时间4.6 d.1例发生术后尿漏.随访6～24个月,平均14个月,UPJ梗阻的症状均消失,影像学检查无梗阻.结论 后腹腔镜下离断性肾盂成形术是治疗小儿UPJ梗阻安全、有效的方法,可以替代开放性手术.     

后腹腔镜离断性肾盂成形术治疗小儿肾盂输尿管连接部梗阻（附16例报告）

目的 探讨后腹腔镜下离断式肾盂成形术治疗小儿肾盂输尿管连接部梗阻的临床应用价值。方法 采用经腹膜后径路施行腹腔镜下离断性肾盂成形术治疗小儿肾盂输尿管连接部梗阻16例。患者中男11例, 女5例, 年龄3.5-12岁,平均年龄6.5岁。右侧7例,左侧9例。异位血管压迫1例,合并肾盂结石1例。结果 16例手术均获成功。手术时间110-175min,平均130min;出血量20-60ml,平均35ml。术后住院时间6-11d,平均8d。随访3-36个月,平均18月;肾盂输尿管连接部吻合口无狭窄, 肾积水得到改善。结论 小儿后腹腔镜下离断式肾盂成形术安全、有效、微创,术后恢复快,可以作为治疗小儿肾盂输尿管连接部梗阻的有效手术方法,值得临床推广。     

Dorsal lumbotomy incision in paediatric pyeloplasty

BACKGROUND: The purpose of the present study was to comprehensively assess the results of surgical management of pelvi-ureteric junction (PUJ) obstruction using lumbotomy as the surgical approach. METHODS: Records of 36 consecutive patients with unilateral PUJ obstruction who underwent pyeloplasty in the last 5 years were reviewed retrospectively. The investigations included renal function tests, ultrasound and serial renal diuretic scans. A micturating cystourethrogram was also done whenever indicated. A dismembered pyeloplasty via lumbotomy was the only surgical approach considered. Thirteen patients had a right pyeloplasty while 23 had a left pyeloplasty. Mean age at diagnosis was 57 months in 31 patients while five were antenatally diagnosed (range 1 month-12 years). Age at surgery ranged from 1 month to 12 years with a mean of 59.9 months. Nine children underwent surgery in infancy. Six patients had a preoperative percutaneous nephrostomy (PCN) placement, five for poorly functioning kidneys (less than 10% split renal function) and one for oliguria. Records were reviewed for age at diagnosis, age at surgery, duration of surgery, preoperative and postoperative split renal function. RESULTS: The follow-up period in the present study ranged from 9 months to 68 months with a mean of 44.9 months. Mean duration of surgery was 78 min of the group as a whole but in PCN patients it was significantly more (100 min vs 71.3 min). Fourteen patients had an improvement in split renal function noticed at 3 and 6 months postoperatively, 17 patients had no change while one patient had a deterioration of split renal function. Four patients had a solitary functioning kidney and in all of these glomerular filtration rate improved postoperatively. Hospital stay was on the average 7.45 days with a range of 6-10 days. However, when a double-J (D-J) stent was used across the anastomosis and the uretero-vesical junction (transrenal D-J stenting), the mean stay was reduced to 3 days. All patients returned to full oral feeds by postoperative day 1. No incidences of wound related problems were encountered. CONCLUSIONS: Pyeloplasty results in predictably good outcome in paediatric PUJ obstruction whenever indicated. The lumbotomy approach avoids muscle cutting, thereby minimizing complications related to wound and assisting with faster recovery. Keeping a double-J (D-J) stent across the anastomosis and the uretero-vesical junction (transrenal D-J stenting) reduces hospital stay.     

Application of strict radiologic criteria to define success in laparoscopic pyeloplasty

PURPOSE: To review our experience and utilize rigorous radiologic criteria to establish success in laparoscopic pyeloplasty. PATIENTS AND METHODS: The hospital records of consecutive adult patients who underwent laparoscopic pyeloplasty for ureteropelvic junction (UPJ) obstruction during a 5-year period at our institution were reviewed. We identified 47 candidates for study inclusion. With one open conversion secondary to excessive fibrosis and one patient requiring repeat laparoscopic pyeloplasty for recurrence, 46 patients with 47 renal units were included for analysis. Thirteen renal units had prior surgery for UPJ obstruction. Preoperative and postoperative symptomatology were compared to determine subjective outcome. Mercaptoacetyltriglycine (MAG3) nuclear renography was performed preoperatively and postoperatively to assess differential renal function (DRF) and obstruction, defined as a T1/2 -20 minutes, and evaluate objective success. There were 34 dismembered and 13 Y-V pyeloplasties. RESULTS: The mean operative time was 341.6 minutes (range 200-717 minutes). The mean preoperative T1/2 was 48.4 minutes (range 14 minutes-xc), with a mean DRF of 39.8% (range 22%-60%). The mean postoperative T1/2 was 9.32 minutes (range 2-27 minutes), and the mean DRF was 39.5% (range 7%-57%). The average length of hospital stay was 2.25 days (range 1-3 days). At a mean follow-up of 19.93 months (range 2-55 months), the subjective success rate was 95.7%, and the objective success rate was 93.6%. CONCLUSION: Even when using strict radiologic criteria to define success, laparoscopic pyeloplasty is found to be similar to open surgery in its efficacy for the correction of adult UPJ obstruction.     

Laparoscopic pyeloplasty in children: Long‐term outcome

Objectives: To asses the safety and efficacy of laparoscopic pyeloplasty in pediatric patients. Methods: Data of pediatric patients under the age of 14 years, who had undergone laparoscopic pyeloplasty from January 2000 to December 2005, were prospectively analyzed. The various parameters recorded were: operative time, blood loss, need for analgesics, intra/postoperative complications, hospital stay and postoperative outcome. Success was defined as either symptomatic improvement and/or better drainage on postoperative isotope renography Results: There were 53 patients with a mean age of 9.12 years (1–14 years) and a male to female ratio of 4.3:1. Dismembered pyeloplasty was done in 41 patients and Foley Y‐V plasty in 12 patients via a transperitoneal approach using 3 ports in 50 children or 4 ports in 3 children. Mean operative time was 181 min (78–369); mean blood loss was 118.01 mL (50–250) with a mean hospital stay of 5.05 days (2–11). Conversion to open surgery was required in 4 (7.54%) patients. Follow‐up renograms were available in 49 patients, which showed improvement in drainage in 44 patients and an obstructed pattern in five; of these, two patients had significant deterioration in split function. Two patients among the obstructed group underwent redo pyeloplasty by open technique while the other three elected for a conservative approach. Thus at a mean follow up of 24.58 months (4–45) the overall success rate was 89.75%. Conclusions: Laparoscopic pyeloplasty is a safe and effective, minimally invasive procedure in pediatric patients with a good intermediate term success rate and minimal morbidity.     

Severe restrictive lung disease and vertebral surgery in a pediatric population

The aim of this study is to describe the outcome of surgical treatment for pediatric patients with forced vital capacity (FVC) <40% and severe vertebral deformity. Few studies have examined surgical treatment in these patients, who are considered to be at a high risk because of their pulmonary disease, and in whom preoperative tracheostomy is sometimes recommended. Inclusion criteria include FVC <40%, age <19 years and diagnosis of scoliosis. The retrospective study of 24 patients with severe restrictive lung disease, who underwent spinal surgery. Variables studied were age and gender, pre- and postoperative spirometry (FVC, FEV1, FEV1/FVC), preoperative, postoperative and late use of non-invasive ventilation (BiPAP) or mechanical ventilation, associated multidisciplinary treatment, type and location of the curve, pre- and postoperative curve values, type of vertebral fusion, intra- and postoperative complications, duration of intensive care unit (ICU) stay and length of postoperative hospitalization. Mean age was 13 years (9–19) of which 13 were males and 11 females. Mean follow-up was 32 months (24–45). The etiology was neuromuscular in 17 patients and other etiologies in 7 patients. Mean preoperative FVC was 26% (13–39%). Eight patients had preoperative home BiPAP, 15 preoperative in-hospital BiPAP, and 2 preoperative mechanical ventilation. Nine patients had preoperative nutritional support. Preoperative curve value of the deformity was 88° (40°–129°). Nineteen patients with posterior fusion alone and 5 with anterior and posterior fusion were found. Mean duration of ICU stay was 5 days (1–21). Total postoperative hospital stay was 17 days (7–33). Ventilatory support in the immediate postoperative includes 16 patients requiring BiPAP and 2 volumetric ventilation. None of the patients required a tracheostomy. The intraoperative complications include one death due to acute heart failure; immediate postoperative, four respiratory failures (2 required ICU readmission) and one respiratory infection; and other minor complications occurred in six patients. Overall, 58% of patients had complications. Percentage of angle correction was 56%. After a follow-up of 30 months, FVC was 29% (13–50%). In conclusion, corrective scoliosis surgery in pediatric patients with severe restrictive lung disease is well tolerated, but the management of this population requires extensive experience with the vertebral surgery involved, and a multidisciplinary approach that includes pulmonologists, nutritionists and anesthesiologists. Currently, there is no indication for routine preoperative tracheostomy.     

Day surgery for pediatric inguinal hernia repair

Pediatric patients with inguinal hernia can be good candidates for day surgery. Since 1986, 1273 such patients have been treated under our day surgery system. Although 8 patients (0.6%) were unable to go home after surgery due to perioperative complications and 21 (1.6%) visited earlier than scheduled after discharge, no major complications were noted and postoperative complications did not differ from those seen in the inpatient setting. Our questionnaire survey demonstrated that 96% of the families were satisfied with the system. Based on our own experience and a literature review of day surgery for inguinal hernia repair in children, the problems surrounding the day care system are discussed. Patient selection, preoperative assessment, general anesthesia, postoperative care including oral intake and analgesia, and postoperative follow-up are considered the most important issues in the day care system. A team approach including pediatric surgeons, anesthesiologists, and pediatric nurses is considered indispensable for the safe and satisfactory day surgery treatment.     

Laparoscopic dismembered pyeloplasty: 50 consecutive cases.

OBJECTIVE: To test the hypothesis that laparoscopic dismembered pyeloplasty offers the same good results as open pyeloplasty, but without the disadvantages of the loin incision (which is painful, prolongs hospitalization and prevents a return to normal activities for several weeks) in the treatment of pelvi-ureteric junction (PUJ) obstruction. PATIENTS AND METHODS: Fifty consecutive consenting patients presenting with PUJ obstruction underwent laparoscopic dismembered pyeloplasty carried out by one surgeon using an extraperitoneal approach. RESULTS: Two (4%) procedures were converted to open surgery. The mean (range) operative duration was 164 (120-240) min. Fifteen (30%) of the patients had their ureter transposed anterior to a crossing lower-pole vessel; 22 (44%) patients had a separate renal pelvic suture line. The mean (range) postoperative parenteral analgesic requirement was 19.1 (0-111) mg of morphine sulphate. The mean (range) hospitalization was 2.6 (2-7) days. Two (4%) patients had complications. After a mean (range) follow-up of 18.8 (3-72) months all but one patient, who had failed endopyelotomy, had a normal renogram and were symptom-free. CONCLUSION: These results suggest that a loin wound is not necessary for a successful outcome after dismembered pyeloplasty, and that in expert hands laparoscopic dismembered pyeloplasty should now be considered the standard of care.