机器人辅助腹腔镜行儿童上尿路手术的护理配合

目的总结机器人辅助腹腔镜行儿童上尿路手术的护理配合经验。方法回顾性分析2017年3月至2017年12月在解放军总医院第七医学中心,接受机器人辅助腹腔镜行上尿路手术140例患儿的临床资料,总结机器人辅助腔镜手术的术前准备、用物准备、手术布局和体位安置等护理配合注意事项。结果 140例患儿中男103例,女37例。平均体重为(18.1±15.0) kg,体重≥40 kg者39例,体重<40 kg者101例。手术的平均体位安置时间为(13.8±5.1)min。所有手术均顺利完成,无中转开放手术,未发生因手术布局及体位不当所导致的手术操作困难及术后相关并发症。结论良好的手术布局、体位安置是机器人辅助腹腔镜行儿童上尿路手术顺利开展与完成的重要前提。良好的手术布局有利于手术团队在手术中协作、交流与配合。良好的体位安置有利于发挥机器人手术优势、有助于主刀灵活操作及其与助手有效地配合,使手术更加安全、有效。     

机器人辅助腹腔镜与传统腹腔镜在儿童肾盂成形术的应用价值

目的:评价机器人辅助腹腔镜在儿童肾盂成形术中的应用价值。方法:收集2018年1月至2019年12月在郑州大学第一附属医院小儿外科接受肾盂成形术的170例患儿的相关资料。将接受腹腔镜肾盂成形术(laparoscopic pyeloplasty,LP)的102例患儿作为LP组,其中男56例,女46例;患侧为左侧79例,右侧...     

机器人辅助腹腔镜与传统腹腔镜输尿管再植术应用对比

目的:比较机器人辅助腹腔镜下输尿管再植术(robot-assisted laparoscopic ureteral reimplantation,RALUR)与传统腹腔镜下输尿管再植术(laparoscopic ureteral reimplantation,LUR)在治疗婴幼儿原发性梗阻性巨输尿管(primary o...     

Lumbotomy approach for upper urinary tract surgeries in adolescents: Feasibility and challenges

ObjectiveThe objective of this study was to assess the feasibility and challenges in a lumbotomy approach for performing upper urinary tract surgeries in adolescent children.Material and methodsFifty-five adolescent children underwent various upper urinary tract surgeries from 2000 to 2012. In all patients, the kidneys and ureters were approached via a lumbotomy incision. The patients' characteristics were analysed from the hospital charts. Intraoperative and postoperative details were gathered from individual case files. Data were collected regarding: age, weight, gender, diagnosis, surgical procedure, anaesthetic details, any intraoperative problems encountered, postoperative pain, time to oral feed, length of hospitalisation and any complications.ResultsThe median age at surgery was 14 years (range 10–19). There were 42 boys and 13 girls. Median weight was 41 kg (range 28–52 kg). Surgeries performed were pyeloplasty, pyelolithotomy, nephroureterectomy and heminephrectomy. Mean duration of surgery was 80 min (range 60–130 min) with no special anaesthetic requirements. No intraoperative problems were encountered. In all patients, postoperative stay was uneventful with minimal analgesic requirements and oral feeding was started the very next day. There were no incision-related complications.ConclusionsA lumbotomy incision is technically easy and safe, even in adolescent children, as an approach for upper urinary-tract surgeries.     

Infant robotic pyeloplasty: Comparison with an open cohort

ObjectiveTo present our experience with infant pyeloplasty, comparing outcomes between robotic-assisted laparoscopic pyeloplasty (RALP) and open pyeloplasty (OP).Materials and methodsA retrospective review was performed of all children <1 year of age who underwent unilateral dismembered pyeloplasty at a single pediatric institution since January 2007. Patients with standard laparoscopic pyeloplasty were excluded. Patient demographics, intraoperative details, narcotic usage, and complications were reviewed.ResultsA total of 70 infants (51 boys and 19 girls) were identified, with nine RALP and 61 OP performed. Median age was 9.2 months (range, 3.7–11.9 months) for RALP and 4.1 months (range, 1.0–11.6 months) for OP (p = 0.005). Median weight was 8 kg (range, 5.8–10.9 kg) for RALP and 7 kg (range, 4–14 kg) for OP (p = 0.163). Median operative time was 115 min (range, 95–205 min) for RALP and 166 min (range, 79–300 min) for OP (p = 0.028). Median hospital stay was 1 day (range, 1–2 days) for RALP and 3 days (range, 1–7 days) for OP (p < 0.001). Median postoperative narcotic use of morphine equivalent was <0.01 mg/kg/day (range, 0–0.1 mg/kg/day) for RALP and 0.05 mg/kg/day (range, 0–2.2 mg/kg/day) for OP (p < 0.001). Median follow-up was 10 months (range, 7.2–17.8 months) for RALP and 43.6 months (3.4–73.8 months) for OP (p < 0.001). The success rate was 100% for RALP and 98% for OP.ConclusionsInfant RALP was observed to be feasible and efficacious with shorter operative time, hospital stay, and narcotic utilization than OP.     

儿童泌尿系统梗阻畸形合并上尿路结石的术中内镜治疗

目的 探讨儿童泌尿系统梗阻畸形外科手术中联合内镜治疗儿童泌尿系统梗阻畸形合并上尿路结石的安全性和有效性.方法 回顾分析我院小儿外科2010年1月1日至2013年8月31日收治的17例儿童泌尿系统梗阻畸形合并上尿路结石的患儿临床资料.男13例,女4例,年龄3～12岁,平均年龄5.9岁,左侧14例,右侧3例.肾积水、UPJO合并肾脏结石11例,输尿管膀胱连接处狭窄合并肾盂内结石3例,输尿管膀胱连接处狭窄合并输尿管末端结石者2例,输尿管膀胱连接处狭窄合并肾输尿管多处结石1例,结石直径4～12 mm.结果 11例肾积水、UPJO(肾盂输尿管连接处狭窄)患儿均顺利行离断式肾盂输尿管成形术,术中均行经肾盂输尿管镜或膀胱镜检查肾盂内各盏,10例患儿成功取出结石,1例术中未见找到结石,术后辅助行体外震波碎石治疗(ESWL).6例输尿管膀胱连接处狭窄(UVJO)患儿均顺利行膀胱外输尿管膀胱再植术,术中4例顺利行输尿管硬镜检查术,2例顺利行输尿管软镜检查术,结石顺利取出4例,2例术中检查未能发现结石.结论 对于儿童泌尿系统梗阻畸形合并上尿路结石,在梗阻畸形外科手术治疗的同时联合内镜治疗上尿路结石是理想、安全、有效的.     

Reactive thrombocytosis in children with upper urinary tract infections

The relationship between reactive thrombocytosis and the level of urinary tract infections was studied in 48 children. Platelets were counted before, during and after treatment. Reactive thrombocytosis was noticed in 74% of children with upper and in 14% with lower urinary tract infections. A significant rise in the platelet count presented in another five children (15%) with upper urinary tract infections. Conclusion: Reactive thrombocytosis was found almost exclusively in the renal parenchymal infections, usually during the recovery phase.     

膀胱高压和上尿路功能损害

目的 探讨脊髓发育不良患儿影响上尿路功能的高危因素。方法 ６０例患儿行常规尿流动力学检查和静脉肾盂造影、排尿时膀胱尿道造影。按漏点压高低分成两组,３２例漏点压高于４０ｃｍＨ２Ｏ为高压组,漏点压低于４０ｃｍＨ２Ｏ２８例为低压组。２２例年龄小于１岁的患儿仅做尿流动力学检查。结果 出现上尿路功能损伤,高压组患儿中１７例（５３．１％）,低压组５例（１７．９％）,Ｐ〈０．０５;逼尿肌括约肌不协调的患儿出现上     

经脐单部位三通道腹腔镜治疗小儿上尿路疾病

目的 探讨经脐单部位三通道腹腔镜治疗小儿上尿路疾病手术的初步应用和体会.方法 2010年9月共完成3例经脐单部位三通道腹腔镜手术,包括肾盂输尿管成形术1例;重复肾重复输尿管切除术1例;乳头式输尿管膀胱再植术1例.结果 全部手术均在单部位腹腔镜下成功完成,无需术中增加套管或开放手术,无术中并发症出现,估计平均出血量小于20 ml,术中术后无输血.手术时间分别为:肾盂成形术200 min、重复肾重复输尿管切除术85 min、输尿管膀胱再植术160 min.均于术后24 h内恢复饮食,重复肾切除术后1 d拔除引流管和尿管,肾盂成形术和输尿管膀胱再植术后2 d拔除引流管,术后7 d拔除尿管.分别于术后10 d、5 d、8 d出院,肾盂成形术和输尿管膀胱再植术患儿均于术后1个月拔除双J管.术后3个月复查,肾盂成形术后患儿复查静脉尿路造影可见吻合口通畅,肾积水减轻;重复肾患儿复查彩超见残存的下肾血供良好,肾核素扫描示分肾功能好;输尿管膀胱再植术后复查静脉尿路造影及膀胱尿道造影未见吻合口狭窄和反流,脐部切口美观.结论 经脐单部位三通道腹腔镜手术用于小儿泌尿外科毁损性和功能重建性手术安全、可行、手术瘢痕小且隐蔽,美容效果好.但因手术器械通道狭小,术中器械之间有相互干扰且活动范围小,使吻合比较困难,单部位腹腔镜重建性手术需谨慎开展.

Abstract：

Objective To review our initial clinical experience of transumbilical single-port laparoscopy in infants with upper urinary tract diseases. Methods In June,2010, we performed transumbilical single-port laparoscopies in 3 patients, including 1 pyeloplasty, 1 heminephroureterectomy and 1 papillary type ureteral reimplantation. Results All cases were completed successfully. No additional trocar was used and no complications were observed. The mean blood loss was less than 20ml. The operative time was 200 min for pyeloplasty,85 min for heminephroureterectomy and 160min for papillary type ureteral reimplantation, respectively. In the pyeloplasty case, the drainage tube and ureter were removed 1 day after surgery. In the last 2 cases, the drainage tubes were removed 2 days post-operatively and urinary catheters were removed 7 days post surgery, respectively. The patients were discharged on the 10th,5th and 8th post-operative day. Double-J ureteral stents were removed 1 month after surgery in the first two patients. After 3 month follow-up, the first patient showed significant alleviation in hydronephrosis,the low pole kidney of the second patient was well and MRU did not demonstrate any reflux in the last patient. Conclusions Applying transumbilical single-port laparoscopic technique in breakage and reconstruct surgery is safe and feasible, with the advantages of less trauma and more cosmetic benefit. However,more specific instruments are required to better apply the technique; difficulties still exist including,limited movement of instruments,suturing and knotting.