腹腔镜手术治疗小儿副肾动脉压迫引起肾积水的临床体会

目的探讨小儿副肾动脉压迫引起肾积水的临床特点及腹腔镜手术治疗的安全性和应用价值。 方法2017年１月至2019年12月我院收治副肾动脉压迫引起肾积水的患儿13例，男9例，女4例，左侧11例，右侧2例。回顾性分析了副肾动脉压迫引起肾积水患儿的临床资料。 结果本组13例均证实副肾动脉压迫肾盂输尿管交界处引起肾积水，副肾动脉起源于腹主动脉11例，起源于肾动脉2例。均在腹腔镜下完成离断式肾盂成形术，置入双J管，吻合口周围放置引流管，术后3~ 6 d拔除。手术时间（120±25）min；出血量（6.0±2.5）ml，患儿手术当天全流食。1例术后第2天出现漏尿，经治疗3 d后愈合。住院时间（8.5±0.5）d。术后随访3~15个月，1例肾萎缩者肾功能继续下降，出现完全无功能，反复出现发热、腰痛等泌尿道感染症状，二期行肾切除术，其余患儿无出现肾功能继续下降。 结论腹腔镜手术治疗小儿副肾动脉压迫引起的肾积水安全，创伤小，术后康复快，具有微创优势。

Clinical experiences of laparoscopy for children with hydronephrosis caused by compression of accessory renal artery

ObjectiveTo investigate the clinical characteristics of hydronephrosis caused by pediatric accessory renal artery compression and the safety and application value of laparoscopic surgery. MethodsFrom January 2017 to December 2019, 13 cases of hydronephrosis caused by accessory renal artery compression were admitted to our hospital, including 9 males, 4 females, 11 on the left side and 2 on the right side. The clinical data were analyzed retrospectively. ResultsAll the 13 cases in this group confirmed obstruction of ureteropelvic junction caused by compression of accessory renal artery, which originated from abdominal aorta in 11 cases and renal artery in 2 cases. All of them underwent detach pyeloplasty by laparoscopy. Double J tube was placed. Drainage tube was placed around anastomotic stoma, and removed 3-6 d after operation. The operation time was (120± 25) min. The blood loss was (6.0±2.5) ml. On the day of surgery, the patient was given a full-flow diet. One patient had urinary leakage on the second day after surgery, and was healed after treatment for 3 days. The patients were hospitalized for (8.5±0.5) days. After 3-15 months of follow-up, the renal function of 1 patient with renal atrophy continued to decline, presenting complete dysfunction, recurrent symptoms of fever, lumbago and other urinary tract infections, and nephrectomy was performed in the second stage, while the other of the children did not continue to decline in renal function. ConclusionLaparoscopy for hydronephrosis caused by pediatric accessory renal artery compression is safe, with small trauma, quick postoperative recovery and minimally invasion.