摘要
目的 比较经脐单孔腹腔镜下半肾切除术与传统开放手术治疗儿童重复肾输尿管畸形的可行性、安全性和疗效.方法 回顾性分析2013年3月至2015年9月采用半肾切除术治疗的重复肾患儿53例的临床资料,以门诊单双号分为两组,A组（29例）：采用经上腹部横切口的半肾切除术,男12例,女17例,平均年龄（46.0±38.3）个月;伴有输尿管膨出12例,输尿管反流7例,输尿管异位开口9例,反复感染8例.B组（24例）：采用直腹腔镜器械的经脐单孔腹腔镜下半肾切除术,男9例,女15例,平均年龄（20.2±28.6）个月;伴有输尿管膨出10例,输尿管反流4例,输尿管异位开口5例,反复感染7例.两组患儿的年龄、性别组成和畸形侧别比较差异均无统计学意义（P＞0.05）.结果 53例手术均顺利完成.B组因术中出血2例分别于下腹部增加1个套管,1例中转开放手术,均发生在手术开展早期.A、B两组的手术时间分别为（137.0±28.8） min和（167.3±43.7） min,差异有统计学意义（P=0.006）;术中出血量分别为（45.7±28.8）ml和（23.2±43.7） ml,输血例数分别为6例和4例,术后恢复饮食时间分别为（1.4±1.5）d和（1.4±1.1）d,留置引流管时间分别为（5.1±1.6）d和（4.1±2.0）d,术后住院时间分别为（8.6±2.0）d和（8.6±2.2）d,差异均无统计学意义（P＞0.05）.术后随访2～31个月,平均18个月,A组出现高血压2例,尿路感染2例,输尿管残端综合征3例,下肾功能丧失1例;B组出现尿路感染3例,尿囊肿1例,输尿管残端综合征1例,两组比较差异均无统计学意义（P＞0.05）.结论 经脐单孔腹腔镜下半肾切除术在有丰富的开放式半肾切除手术经验,能常规开展三、四类腹腔镜手术的小儿泌尿外科医疗机构中是安全、简便、有效的,手术时间可达到或低于开放手术水平,手术创伤减小,美容效果明显.
Objective To compare the outcome of transumbilical laparoendoscopic single-site surgery with conventional open surgery for duplex kidney in children.Methods Retrospective analysis of 53 cases undergone partial nephrectomy,performed in 32 girls and 21 boys with the mean age of （35.8 ± 36.8） months from March 2013 to September 2015.The patients were divided into 2 different groups by odd and even outpatient service numbers.Group A：conventional open surgery of partial nepherectomy（n =29）;Group B：transumbilical laparoendoscopic single-site Heminephroureterectomy （n =24）.In group A,there were 12 boys and 17 girls,12 of ureterocele,7 of vesieoureteral reflux （VUR）,9 cases were of ectopie ureter and 8 of urinary tract infection （UTI）,mean age was （46.0 ±38.3） months.In group B,there were 9 boys and 15 girls,10 of ureterocele,4 of VUR,5 cases were of ectopie ureter and 7 of UTI,mean age was （20.2 ± 28.6） months.There was no statistically significant difference in age,gender composition,affected side.Results 53 operations were done successful.There was 1 case conversion to open surgery and 2 cases added an additional port besides the umbilicus in Group B,and all occurred in the early stage of the study.Compared Group A with Group B,the operation time[（137.0 ± 28.8） min vs.（167.3 ± 43.7） min,P =0.006];blood loss [（45.7 ± 28.8） ml vs.（23.2 ± 43.7） ml,P =0.134];blood transfusion （6 vs.4,P =0.709）;time of resumption to a regular diet[（1.4 ±1.5） d vs.（1.4 ＋1.1） d,P=0.785];time of indwelling drainage tube [（5.1 ± 1.6） d vs.（4.1 ± 2.0） d,P =0.200];postoperative hospital stay [（8.6 ± 2.0） d vs.（8.6 ± 2.0） d,P =0.725].The mean time of follow up after surgery is 18.2 months （2-31 months）.Complications after surgery between group A and B included hypertension （2 vs.0,P =0.495）;urinary tract infection （2 vs.3,P =0.824）,distal ureterie stump （DVS） （0 vs.1,P =0.453）and renal functional loss （1 vs.0,P =1.000）.Conclusion The transumbilical laparoendoscopic single-site heminephrectomy is safe,feasible,effective in experienced pediatric urologic surgeons and high volume centres.It can reach or even exceed the effect of traditional open surgery.After the learning period,the operation time was significantly shortened,and can reach or be lower than open surgery time.Transumbilical laparoendoscopic single-site surgery （LESS） has the advantages of reduce the surgical trauma and better cosmetic results.
出处
《中华泌尿外科杂志》
CAS
CSCD
北大核心
2016年第3期184-189,共6页
Chinese Journal of Urology
基金
安徽省高等学校省级质量工程项目“泌尿外科技能虚拟仿真实验教学中心”（2014xnzx02）
关键词
腹腔镜
重复肾输尿管
半肾切除术
单孔腹腔镜手术
Laparoendoscopic
Duplex kidney
Heminephroureterectomy
Laparoendoscopic single-site surgery
