CAJ | 학술논문

目的探讨经脐多切口腹腔镜肾盂成形术治疗新生儿重度肾积水(肾盂输尿管连接部梗阻PUJO)可行性、安全性及初步经验分析.方法本组患儿21例,为2009年6月至2012年6月收治的新生儿肾积水,其中男14例,女7例,左侧14例,右侧5例,双侧2例;本组病例入选标准:均由产前超声检出,肾盂前后径均大于3 cm,出生1周后查患侧分肾功能低于40％;均采用经脐多切口腹腔镜离断式肾盂成形术.结果 21例患儿手术均获成功,无中转开放或另外增加Trocar,无术中并发症.单侧平均手术时间75 min,双侧平均手术时间185 min,术中平均出血量＜10 ml,术后平均住院时间9d.术后采用超声、放射性核素扫描随访6～36个月,均显示吻合口通畅,肾实质均有不同程度增厚,肾盂前后径均明显减小,患肾分肾功能不同程度恢复,术后瘢痕不明显,8例术后肾盂前后径＜1.0cm,形态接近正常.结论经脐多切口腹腔镜肾盂成形术治疗新生儿重度肾积水安全可行,创伤小,恢复快,疗效好,美容效果良好,值得推广.
목적 탐토경제다절구복강경신우성형술치료신생인중도신적수(신우수뇨관련접부경조PUJO)가행성、안전성급초보경험분석.방법 본조환인21례,위2009년6월지2012년6월수치적신생인신적수,기중남14례,녀7례,좌측14례,우측5례,쌍측2례;본조병례입선표준:균유산전초성검출,신우전후경균대우3 cm,출생1주후사환측분신공능저우40％;균채용경제다절구복강경리단식신우성형술.결과 21례환인수술균획성공,무중전개방혹령외증가Trocar,무술중병발증.단측평균수술시간75 min,쌍측평균수술시간185 min,술중평균출혈량＜10 ml,술후평균주원시간9d.술후채용초성、방사성핵소소묘수방6～36개월,균현시문합구통창,신실질균유불동정도증후,신우전후경균명현감소,환신분신공능불동정도회복,술후반흔불명현,8례술후신우전후경＜1.0cm,형태접근정상.결론 경제다절구복강경신우성형술치료신생인중도신적수안전가행,창상소,회복쾌,료효호,미용효과량호,치득추엄.
Objective To investigate the feasibility and safety of laparoscopic pyeloplasty for treatment of newborns with ureteropelvic junction obstruction (UPJO).Methods Twenty-one newborns (14 males and 7 females) with hydronephrosis from June 2009 to June 2012 were enrolled in the study.Among them,14 patients had left hydronephrosis,5 had right hydronephrosis,and 2 had bilateral hydronephrosis.The criteria for surgery were:①hydronephrosis with pelvic anteroposterior diameter greater than 3 cm on prenatal ultrasound;②ipsilateral renal function less than 40％ when examined a week after birth.These patients were treated through multi-incision transumbilical laparo scopic dismembered pyeloplasty technique.Results All 21 patients had successful operation with no conversion and no intraoperative complication.The mean operative time was 75 min for patients with unilateral hydronephrosis and 185 min for patients with bilateral hydronephrosis.The mean intraoper ative blood loss was less than 10 ml.The mean hospital stay was 9 days.Length of follow up of the patients varied from 6 to 36 months using ultrasound and radionuclide scans.These showed anastomotic patency,varying degree of renal parenchyma thickening,significantly reduced renal pelvic anteroposterior diameter and varying degrees of renal function recovery.In addition,the operative scars were not obvious.Conclusions Transumbilical laparoscopic pyeloplasty for newborns is feasible,safe and less invasive and has better cosmetic outcomes.