小儿经腹肠系膜间隙入路腹腔镜下肾盂成形术的疗效观察

Observation on the curative effect of laparoscopic pyeloplasty through transmesenteric approach in children

摘要:

目的 总结经腹肠系膜间隙入路行腹腔镜下肾盂成形术的临床经验，探讨该术式治疗小儿左侧肾盂输尿管连接部狭窄导致肾盂积水的疗效。方法 回顾性分析2014年5月－2020年5月该院18例采取经腹肠系膜间隙入路行腹腔镜下肾盂成形术患儿的临床资料。其中，男10例，女8例，年龄3～14岁，平均（5.7±2.9）岁，均为左侧。均采用经腹腔肠系膜间隙入路，术中将切开的肠系膜间隙用丝线悬吊于腹壁，便于手术野暴露。裁剪多余的肾盂后，采用Anderson-Hynes技术行肾盂输尿管成形术，自吻合口留置输尿管支架。统计手术时间、术中出血量、术后住院时间、术后肠道功能恢复时间，总结手术技巧及经验。术后通过彩超和发射体层仪（ECT）肾动态显像来评价手术效果。结果 18例患者均顺利完成手术，无中转开腹，手术时间75～130 min，平均（98.2±17.7）min，术中出血量5～20 mL，平均（10.0±3.7）mL，术后肠道功能恢复时间1～4 d，平均（1.9±1.0）d，术后住院时间2～5 d，平均（2.1±1.2）d，术后随访6～24个月，患者临床症状逐渐消失，术后6个月复查超声：肾盂前后径（APD）（7.9±1.7）mm，较术前的（34.8±2.0）mm明显缩小（P = 0.000），术后6个月复查患侧分肾功能为（40.1±2.9）%，较术前的（28.1±3.0）%明显改善（P = 0.000），手术成功率为100%。结论 该入路行腹腔镜下肾盂成形术安全、有效，对患儿肠道影响较小，有利于患儿术后快速康复。

Abstract:

Objective To summarize the clinical experience of laparoscopic pyeloplasty via transmesenteric approach, and explore the therapeutic effect of this procedure.Methods A retrospective analysis was made on the clinical data of 18 cases of children underwent laparoscopic pyeloplasty via transmesenteric approach from May 2014 to May 2020, including 10 males and 8 females, age from 3 to 14 years old, an average of (5.7 ± 2.9) years old. All patients are on the left. Through the transmesenteric approach, the incised mesenteric space is suspended on the abdominal wall with silk thread during the operation to facilitate the exposure of the surgical field. After cutting the excess renal pelvis, the Anderson-Hynes technique was used to perform ureteroplasty, and the ureteral stent was indwelling from the anastomotic site. Operation time, intraoperative blood loss, postoperative hospital stay, postoperative intestinal function recovery time, and summary of surgical skills and experience were recorded. After operation, color Doppler ultrasound and emission computed tomography (ECT) renal dynamic imaging were used to evaluate the effect of the operation.Results All the 18 cases were successfully completed without conversion to laparotomy. The operation time was 75 ~ 130 min, an average of (98.2 ± 17.7) min, the operative blood loss was 5 ~ 20 mL, an average of (10.0 ± 3.7) mL, the postoperative intestinal function recovery time was 1 ~ 4 d, an average of (1.9 ± 1.0) d. Postoperative hospital stay time was 2 ~ 5 d, an average of (2.1 ± 1.2) d. After 6 ~ 24 months of follow-up, the patient's clinical symptoms gradually disappeared. Ultrasound was re-examined 6 months after the operation: the anterior and posterior diameter of the renal pelvis was (7.9 ± 1.7) mm, which was significantly smaller than the preoperative (34.8 ± 2.0) mm (P = 0.000), the renal function of the operated side (40.1 ± 2.9)% was significantly improved (P = 0.000) compared with the preoperative (28.1 ± 3.0)% at 6 months after the operation, the success rate of surgery was 100%.Conclusion The transmesenteric approach laparoscopic pyeloplasty is safe and effective in the treatment of children with ureteropelvic junction obstruction (UPJO), and the trans-mesenteric space approach has little effect on the intestines of children, which is conducive to the rapid recovery of children after surgery.