序贯悬吊在腹腔镜Lich-Gregoir术治疗儿童原发性膀胱输尿管反流中的应用

目的探讨序贯悬吊法在腹腔镜Lich-Gregoir手术治疗儿童原发性膀胱输尿管反流(primary vesicoureteral reflux,VUR)中的安全性和有效性。方法回顾性分析电子科技大学医学院附属妇女儿童医院2017年4月至2018年4月采用序贯悬吊法辅助完成腹腔镜Lich-Gregoir手术治疗儿童原发性膀胱输尿管反流的14例患儿临床资料。14例患儿均因反复尿路感染入院,男5例,女9例;平均年龄36个月,范围9~72个月;右侧8例,左侧6例。术前Ⅲ级反流3例,Ⅳ级或Ⅴ级反流11例,肾图提示存在肾瘢痕。结果14例患儿均在腹腔镜下顺利完成手术,无中转开腹者。平均手术时间为45 min,范围40~63 min;术中平均出血量3.5 ml,范围2~8 ml。术后3个月复查排泄性尿路造影检查,仅1例为Ⅰ级反流,余均未见反流,术后6个月泌尿系超声造影检查、术后9个月排泄性膀胱尿道造影(voiding cystourethrography,VCUG)检查均未见有反流。术后6个月复查肾图未发现新的肾瘢痕出现。14例患儿随访至今无尿路感染发生。结论腹腔镜Lich-Gregoir手术操作中采用腹壁序贯悬吊法,能安全有效的暴露术野,并缩短切开膀胱浆肌层和包埋输尿管的操作时间。

Application of abdominal sequential suspension in Laparoscopic Lich-Gregoir procedure for primary vesicoureteral reflux in children

Objective To explore the safety and efficacy of abdominal sequential suspension in laparoscopic Lich-Gregoir procedure in children with primary vesicoureteral reflux(VUR).Methods From April 2017 to April 2018,clinical data were retrospectively analyzed for 14 children with primary VUR undergoing laparoscopic extravesical reimplantation(Lich-Gregoir technique).Results All children were hospitalized for recurrent urinary tract infection.There were 5 boys and 11 girls with a mean age of 36(9-72)months.The involved side was left(n=6)and right(n=8).GradesⅢ(n=3)andⅣ/Ⅴ(n=11)of VUR were confirmed by voiding cystourethrography(VCUG).Renal scars were assessed by dimercaptosuccinic acid(DMSA)scan.All laparoscopic Lich-Gregoir operations were successful.The average operative duration was 45(40-62)min and the mean intraoperative blood loss 3.5(2-8)ml.The disappearance of VUR was confirmed by VCUG in all children at 3 months postoperatively,except one with grade I.No reflux occurred on contrast-enhanced ultrasonography at 6 months postoperatively and VCUG at 9 months postoperatively.There was no recent renal scarring or urinary tract infections since then.Conclusions During laparoscopic Lich-Gregoir operation,abdominal sequential suspension can effectively expose surgical field and shorten the operative duration of cutting bladder muscle layer and embedding ureter.