耻骨上辅助经脐单孔腹腔镜小儿重复肾切除术（附9例报告）

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摘要 目的:探讨耻骨上辅助经脐单孔腹腔镜技术（SA-LESS）在小儿重复肾畸形治疗中的应用价值。 方法:本组9例，男3例，女6例，中位年龄9（2~15）岁。左侧5例，右侧4例。包括重复肾输尿管畸形4例，重复肾并巨输尿管积脓1例，重复肾并重复输尿管异位开口2例，重复肾并重复输尿管囊肿2例。均施行SALESS重复肾切除术。记录手术时间、术中出血量、术后住院时间、术中和术后并发症及随访情况。 结果:9例手术均成功，术中、术后未出现肠管、实质性器官和大血管损伤以及肠梗阻等并发症。中位手术时间81（60~130）min；术中中位失血量35（10~50）ml，均未输血；术后中位住院时间7.5（7~10）d。随访2~43个月，脐部穿刺孔及耻骨上切口均愈合良好，脐部瘢痕不明显，均无切口疝发生。彩超及肾ECT提示患侧下半肾功能良好，无肾周尿囊肿形成。 结论:SALESS小儿重复肾切除术安全可行，具有创伤小、美容效果佳、手术难度和风险相对较低、手术时间短等优势，值得临床应用。

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关键词 ：单孔腹腔镜术, 耻骨联合, 肾切除术, 儿童

Abstract：ObjectiveTo evaluate the applied value of suprapubicassisted umbilical laparoendoscopic singlesite surgery (SALESS) for duplex kidney in children. MethodsNine consecutive patients including 3 males and 6 females, with a mean age of 9 (ranging 2 to 15) years, were subjected to SA-LESS heminephrectomy in our center. There were 1 duplex kidney with megaureter empyema, 4 duplex kidneys with duplication of ureter, 2 duplex kidneys with ectopic ureteral orifice and 2 duplex kidneys with ureterocele in our study. Operative time, estimated blood loss, intro- and post-operative complications, length of postoperative hospitalization and follow-up outcomes were recorded. ResultsAll the 9 procedures were successfully performed without conversion to open surgery. There were no intraoperative or postoperative complications. The median operative time was 81 (ranging 60 to 130) min. The median estimated blood loss was 35 (ranging 10 to 50) mL. No blood transfusions were required. Mean postoperative hospital stay was 7.5 (ranging 7 to 10) days. During the follow-up period of 2 to 43 months, the suprapubical and umbilical incisions were healed well. The umbilical incision was hidden and difficult to find. No incisional hernia occurred. No peri-renal urinary cyst and severe loss of renal function were found by ultrasound and nephrogram. ConclusionsSALESS for duplex kidney is safe, feasible, minimally invasive and cosmetic, while operation difficulty and risk are relatively low with shorter operation time. It is worth of clinical application.

Key words： laparoendoscopic single-site surgery pubic symphysis nephrectomy children

ZTFLH:

R692

基金资助:国家高技术研发计划（863计划）项目（2012AA021100)；江西省“赣鄱英才555工程”领军人才培养计划项目；江西省科技厅重大科技支撑计划项目（20121BBG70032、20132BAB205007）；江西省卫生厅重大科技计划项目（20104008）；江西省教育厅科技落地计划项目（KJLD12044）

通讯作者: 邹晓峰，张国玺 E-mail: gyfyurology@126.com;zgx8778@163.com

引用本文:

吴玉婷,徐辉,张国玺,邹晓峰,袁源湖,肖日海,刘潜,伍耿青,王晓宁,龙大治,刘佛林,杨军,廖云峰;△共同第一作者. 耻骨上辅助经脐单孔腹腔镜小儿重复肾切除术（附9例报告）[J]. 微创泌尿外科杂志, 2015, 4(1): 6-10.
Wu Yuting,Xu Hui,Zhang Guoxi,Zou Xiaofeng,Yuan Yuanhu,Xiao Rihai,Liu Qian Wu Gengqin,Wang Xiaoning,Long Dazhi,Liu Fulin,Yang Jun,Liao Yunfeng. Suprapubic-assisted umbilical laparoendoscopic single-site surgery for duplex kidney in children: A report of 9 cases. JOURNAL OF MINIMALLY INVASIVE UROLOGY, 2015, 4(1): 6-10.

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http://journal20.magtechjournal.com/Jwk_zgmnwk/CN/abstract/abstract736.shtml 或 http://journal20.magtechjournal.com/Jwk_zgmnwk/CN/Y2015/V4/I1/6

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