单线悬吊法在小儿腹腔镜肾盂成形术中的应用

Application of single-wire suspension in laparoscopic pyeloplasty in children

摘要:

目的： 探讨单线悬吊法在小儿腹腔镜肾盂成形术中的临床应用价值。方法： 收集淮安市妇幼保健院2019年1月至2021年6月期间采取单线悬吊法行小儿腹腔镜肾盂成形术14例，其中男9例，女5例。年龄2个月13 d至8岁7个月，平均年龄2岁9个月。左侧11例，右侧3例。所有患儿术前常规检查无明显异常，均行排泄性尿路造影（intravenous urography，IVU）和核磁共振尿路水成像（magnetic resonance urography，MRU）检查明确诊断。术中采用单线悬吊法进行腹腔镜下裁剪肾盂及输尿管，然后行精细的肾盂输尿管无张力吻合。术后结合尿液检查和超声检查结果制定个体化随诊方案。结果： 14例均顺利完成手术，均行一期吻合，无一例中转开放，无输血情况发生，手术时间110~155 min，平均手术时间为140 min。术中出血4~8 mL，主要发生在对肾盂及输尿管进行剪裁时。术后3~7 d拔除腹腔引流管，7~20 d拔除导尿管。6~8周后膀胱镜下拔除双J管。术后随访6~12个月，14例患者肾盂前后径进行性减小，肾盂及肾盏逐渐回缩。无吻合口狭窄、尿外渗、积水复发、尿路感染等并发症。结论： 单线悬吊法行小儿腹腔镜肾盂成形术便于肾盂输尿管的精准吻合，是一种简便、安全、有效的手术方法，值得临床推广。

Abstract:

Objective: To investigate the clinical value of single-wire suspension in laparoscopic pyeloplasty in children. Methods: A total of 14 cases of laparoscopic pyeloplasty in children were collected from Huai'an Maternal and Child Health Care Hospital from January 2019 to June 2021, including 9 males and 5 females. Age ranged from 2 months and 13 days to 8 years and 7 months, with mean age of 2 years and 9 months. There were 11 cases on the left and 3 cases on the right. Preoperative routine examination of all the children showed no obvious abnormalities, and the diagnosis was confirmed by intravenous urography (IVU) and magnetic resonance urography (MRU) . During the operation, the renal pelvis and ureter were cut out by single-wire suspension method under laparoscope, and then fine pyelo-ureter tension-free anastomosis was performed. Combined with the results of urine examination and ultrasound examination, individualized follow-up plan was formulated. Results: All the 14 cases had successful operation, and all underwent primary anastomosis. No case was transferred and opened, and no blood transfusion occurred. The operation time was 110-155 min, and the average operation time was 140 min. Intraoperative bleeding of 4-8 mL mainly occurred during the cutting of the renal pelvis and ureter. Abdominal drainage tube was removed 3-7 days after surgery, and catheter was removed 7-20 days after surgery. After 6-8 weeks, the double J tubes were removed under cystoscopy. After 6-12 months of follow-up, 14 patients showed progressive reduction of anterior and posterior renal pelvis diameter and gradual retraction of renal pelvis and calyces. No anastomotic stenosis, urine extravasation, recurrent hydronephrosis, urinary tract infection and other complications. Conclusion: Laparoscopic pyeloplasty in children by single-wire suspension method is convenient for accurate anastomosis of renal pelvis and ureter. It is a simple, safe and effective surgical method, which is worthy of clinical promotion.