论文部分内容阅读
目的:总结机器人辅助腹腔镜肾盂成形术在小儿小肾盂，即肾盂前后径(anteroposterior diameter，APD)<2.5 cm的输尿管肾盂连接部梗阻(ureteropelvic junction obstruction，UPJO)患儿中的应用经验。方法:回顾性分析2018年3月至2019年10月收治的行达芬奇机器人辅助腹腔镜下肾盂成形术(robotic-assistant laparoscopic pyeloplasty，RALP)的12例小肾盂UPJO患儿的临床资料。其中，男7例，女5例；年龄4～15岁，平均7岁；患侧为左侧9例，右侧3例。术前1～7 d患儿B型超声检查提示APD3.5 cm。核素检查提示患儿患肾功能有不同程度的下降，患肾分肾功能在6%～43%。结果:12例RALP手术均顺利完成，无中转开放手术者。其中3例为单纯扭曲狭窄所致UPJO，3例为输尿管肾盂连接部(ureteropelvic junction，UPJ)处息肉的病变，4例为异位血管压迫，1例为UPJ处结石嵌顿伴感染，1例为腔静脉后输尿管。手术时间115～225 min，平均165 min；其中输尿管肾盂吻合时间40～60 min，平均50 min。术中无合并症，平均出血量<10 ml。患儿随访2～22个月，平均12个月。本组术后APD为(1.16±0.82)cm，与术前(1.87±0.57)cm比较，差异有统计学意义(n P<0.05)。n 结论:机器人辅助腹腔镜下肾盂成形术可在小儿小肾盂UPJO中应用并能取得较好结果，操作相对较易掌握，临床应用前景较好。“,”Objective:To summarize the experience of robotic-assistant laparoscopic pyeloplasty (RALP) for ureteropelvic junction obstruction (UPJO) with small pelvis in children.Methods:A retrospective analysis was performed on clinical data of 12 UPJO children (small pelvis) undergoing RALP from March 2018 to October 2019. Their clinical presentations, operative approaches and follow-up data were analyzed. There were 7 boys and 5 girls with a mean age of 7(4-15) years. The involved side was left (n n=9) and right (n n=3). Ultrasound at 1-7 days preoperatively indicated anterioposterior diameter (APD)3.5 cm during an on set of abdominal pain. And radionuclide examination hinted at different declining levels of renal function and the function of affected kidney ranged from 6% to 43%.n Results:RALP was performed all successfully without a conversion into open surgery. The pathogenesis was simple stricture or torsion (n n=3), polyps (n n=3), ectopic vascular compression (n n=4), calculus incarceration with infection (n n=1) and postcaval ureter (n n=1). The average operative duration was 165(115-225) min and the average ureteropelvic anastomosis time 50(40-60) min. There were no obvious intraoperative complications and the mean volume of blood loss was <10 ml. The average follow-up period was 12(2-22) months. The mean preoperative value of APD was (1.87±0.57)cm and the mean postoperative value of APD (1.16±0.82)cm ( n P<0.05).n Conclusions:Robot-assisted laparoscopic pyeloplasty may be employed for pediatric UPJO with small renal pelvis (APD<2.5 cm). Such a technique is easy to learn and clinical application prospects are excellent.