非钳夹式吻合口缝合法在腹腔镜离断式肾盂成形术中的应用

目的 探讨“非钳夹”式吻合口缝合法在腹腔镜肾盂输尿管成形术治疗小儿肾盂输尿管连接部梗阻(UPJO)的手术技巧、疗效及临床应用价值.方法 2015年1月至2015年4月对我院收治的81例肾盂输尿管连接部梗阻小儿肾积水患儿行“非钳夹”式吻合口缝合法经脐单部位腹腔镜肾盂输尿管成形术,其中男68例,女13例,左侧57例,右侧24例,平均年龄3.5岁(11d至15岁),所有患儿术前均行泌尿系B型超声、MRU及MAG3肾核素扫描等检查明确诊断.采用经脐单部位建立手术操作通道,吻合肾盂输尿管前后壁时,离肾盂输尿管吻合口最低点1.0～1.5 cm处于肾盂瓣及输尿管前后壁分别用4-0慕斯线牵引用于缝合吻合口时钳夹与牵拉用,其余方法基本同普通腹腔镜肾盂输尿管成形术.结果 81例患儿手术均获得成功,无中转开放手术,无术中并发症,有2例大龄右侧病变患儿术中在上腹部增加一5 mmTrocar后完成手术.平均手术时间94(80～150)min、术中平均出血量15(10～50)ml、平均引流管拔除时间5(3～10)d、术后平均住院时间7(5～10)d.术后行超声、放射性核素扫描随访3～6个月,术侧肾实质不同程度增厚,肾盂前后径明显减小或消失,62例形态接近正常,患肾分肾功能不同程度恢复.结论 腹腔镜肾盂输尿管成形术治疗小儿肾积水时采用“非钳夹”式吻合口缝合法安全可行,具有损伤小、恢复快、成功率高等优点,值得临床推广应用.

Application of non-clamping laparoscopic pyeloplasty for ureteropelvic junction obstruction

Objective To summarize the experience and efficacy of non-clamping single-site transumbilical laparoscopic Anderson-Hynes dismembered pyeloplasty for UPJO (ureteropelvic junction obstruction) in infants and children.Methods The clinical data of 81 patients undergoing non-clamping single-site transumbilical laparoscopic pyeloplasty for UPJO were analyzed retrospectively between January 2015 and April 2015.There were 68 boys and 13 girls with a median age of 3.5 years (range,11 days to 15 years).Hydronephrosis was left (n =57) and right (n =24).Ultrasonography,magnetic resonance urography (MRU) and MAG3 renogram scan were performed.A 4-0 traction line was passed through a point of 1.0-1.5 cm superior to the lower corner of pelvic lobe and the lowest point of ureteral incision for minimizing clamping of ureteral mucosa and renal pelvis during anastomosis.Results All operations were successful without any conversion into open procedure.The mean operative duration was 94(80～150) min,mean volume of estimated blood loss 15(10～50) ml and mean postoperative hospital stay 7 (5 ～ 10) days.The abdominal drainage tubes were removed after a mean of 5(3～10) days.The mean follow-up time was 4.0 (3～6) months.All double-J stents were removed after 6-8 weeks.And abdominal surgical scar was minimal.Conclusions The non-clamping single-site transumbilical laparoscopic pyeloplasty is ideal for UPJO with a high success rate and excellent cosmetic outcomes.And it is worthy of wider clinical applications.