腹腔镜重建性手术治疗小儿重复肾畸形合并肾盂输尿管连接部梗阻（附5例报告）

doi:10.19558/j.cnki.10-1020/r.2019.01.002

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摘要目的总结腹腔镜下行重建性手术治疗重复肾畸形合并UPJO的临床经验。方法回顾性分析2015年9月–2017年1月收治的5例重复肾畸形合并UPJO患儿临床资料,其中男1例,女4例,中位年龄16.2（3~66）个月。重复肾畸形合并UPJO位于左侧2例,右侧3例。术前所有患儿均行超声、MRU、IVP及肾核素扫描等检查明确重复肾畸形且肾功能良好,术中证实UPJO合并不完全性重复肾输尿管畸形2例,UPJO合并完全性重复肾输尿管畸形3例。手术均经腹腹腔镜建立操作通道,其中行离断式肾盂成形术2例,输尿管-肾盂吻合术2例,离断式肾盂成形术+输尿管-肾盂吻合术1例。结果 5例患儿均在腹腔镜下完成手术,无中转开放手术,无术中术后严重并发症。平均手术时间136.8（100~198）min,平均术中出血量12（5~20）mL,术后平均住院6.2（5~8）d。术后行超声、IVP及肾动态显像检查,所有患儿梗阻均获解除,超声及IVP提示原重复肾积水明显缩小,肾动态显像无梗阻表现。结论对于不同重复肾输尿管畸形需根据术前影像学检查结合术中探查情况采取相应手术方法,腹腔镜下重建性手术治疗重复肾畸形合并UPJO安全可行。

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	曹华林
	周辉霞
	马立飞
	刘德鸿
	周晓光
	陶天

关键词 ：腹腔镜, 重复肾输尿管畸形, 肾盂输尿管连接部梗阻, 肾盂成形, 儿童

Abstract：Objective： To summarize our experience in laparoscopic reconstructive surgery in children with ureteropelvic junction obstruction (UPJO) associated with duplex anomalies. Methods： The clinical data of 5 patients with UPJO associated with duplex renal anomalies were analyzed retrospectively between September 2015 and January 2017 in our institution. There were 1 male and 4 females with a median age of 16.2 (range 3 to 66 months) months, 2 patients had left hydronephrosis and 3 had right hydronephrosis, who were diagnosed by ultrasonography, IVP, MRU, and 99mTc DTPA renal scan etc. Intraoperative investigations confirmed that 2 patients had incomplete duplicated systems and 3 patients had complete duplicated systems with UPJO. The trans-peritoneal laparoscopic approach was utilized in all cases. Two patients underwent dismembered pyeloplasty, 2 patients underwent pyeloureterostomy and one patient underwent dismembered pyeloplasty and pyeloureterostomy. Results： All surgeries were successfully performed without open conversion. No severe intra-operative and post-operative complications were encountered. The mean operative time was 136.8 min (range 100-198 min) and the mean estimated blood loss was 12.0 mL (range 5-20 mL). The mean postoperative hospital stay was 6.2 days (range 5-8 days). Patients were followed up in our clinic postoperatively. All patients got complete clinical and radiologic resolution. The hydronephrosis was reduced on ultrasound and IVP, and the anastomosis was patenct on 99mTc DTPA scans after 6 months postoperation.Conclusions： Different techniques should be adopted according to pre- and intraoperative findings for UPJO in children with duplex renal anomalies. Laparoscopic reconstructive operation is a feasible option in cases of UPJO with duplex renal anomalies.

Key words： laparoscopy duplex kidney anomaly ureteropelvic junction obstruction pyeloplasty child

收稿日期: 2018-08-03

ZTFLH:

R692.1

基金资助:首都卫生发展科研专项（2016-2-5091）;卫生部行业科研专项基金（201402007）;北京市科技计划（Z111107067311062）

通讯作者: 周辉霞, huixia99999@163.com

引用本文:

曹华林, 周辉霞, 马立飞, 刘德鸿, 周晓光, 陶天. 腹腔镜重建性手术治疗小儿重复肾畸形合并肾盂输尿管连接部梗阻（附5例报告）[J]. 微创泌尿外科杂志, 2019, 8(1): 7-11.
CAO Hualin, ZHOU Huixia, MA Lifei, LIU Dehong, ZHOU Xiaoguang, TAO Tian. Laparoscopic reconstructive operations for ureteropelvic junction obstruction in children with duplex renal anomalies. JOURNAL OF MINIMALLY INVASIVE UROLOGY, 2019, 8(1): 7-11.

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