后腹腔镜精准辅助小切口离断肾盂成形术治疗小儿肾盂输尿管连接部梗阻(附22例报告)

目的探讨后腹腔镜精准辅助小切口离断肾盂成形术治疗小儿肾盂输尿管连接部梗阻(UPJO)的手术技巧和临床价值。方法 22例小儿UPJO行后腹腔镜精准辅助小切口离断肾盂成形术。其中,男15例,女7例,年龄6个月~8岁,平均3.5岁;左侧13例,右侧7例,双侧肾积水2例。结果辅助小切口长度1.5~4.0 cm,平均2.6 cm,手术时间42~95 min,平均63 min,术中出血量5~30 ml,平均15 ml,术后住院时间5~12 d,平均6.6 d。围手术期尿漏1例,因术后护理不当夹闭导尿管导致,术后延长伤口引流管留置时间后治愈。术后随访3~24个月,复查B超及尿路造影(CTU)显示肾积水及肾功能均得到改善,尿常规正常。结论对于部分小儿UPJO,后腹腔镜精准辅助小切口离断肾盂成形术是一种微创、安全而有效的手术治疗方法。

Accurate mini-incision dismembered pyeloplasty assisted by retroperitoneal laparoscopy in treatment of children ureteropelvic junction obstruction (22 cases)

Abstract: Objective To investigate the surgical techniques and clinical value of accurate mini-incision dismembered pyeloplasty assisted by retroperitoneal laparoscopy in treatment of children ureteropelvic junction obstruction. Methods 22 cases of children ureteropelvic junction obstruction after accurate mini-incision dismembered pyeloplasty assisted by retroperitoneal laparoscopy, 15 cases are male, and 7 cases are female. Age is from 6 months to 8 years old, average 3.5 years old. 13 cases are on the left side and the right side in 7 cases ,bilateral hydronephrosis in 2 cases. Results Assisted mini- incision length is from 1.5 ~ 4.0 cm, average length is 2.6 cm; Operation time: 42 ~ 95 min, the average is 63 min. Intraoperative blood loss 5 ~ 30 ml, the average is 15 ml; Postoperative hospital stay 5 ~ 12 d, the average is 6.6 d. 1 case of perioperative urine leakage is cure, as a result of improper postoperative nursing catheter clip, by prolong postoperative wound drainage tube indwelling time. Postoperative follow-up is from 3 ~ 24 months, check of ultrasound and CTU showed hydronephrosis and renal function are improved, routine urine is normal. Conclusion For some children with UPJ obstruction, accurate mini-incision dismembered pyeloplasty assisted by retroperitoneal laparoscopy is a minimally invasive, safe and effective surgical treatment method.