CAJ | 학술논문

目的介绍经脐多通道腹腔镜下肾盂成形术治疗小于3个月重度肾积水患儿的初步经验. 方法回顾性分析2010年6月至2013年3月72例小于3个月的肾盂输尿管连接处梗阻所致重度肾积水患儿的病例资料.手术时年龄7～87 d,平均34 d.手术干预指证:①美国小儿泌尿外科学会分级4度;②分肾功能占比＜40％.患儿均行经脐多通道腹腔镜下肾盂成形术.术后进行随访,随访内容包括查体、超声检查和核素检查. 结果 72例手术均获成功,无中转开放者,术中无额外放置套管者,未发生术中并发症.手术时间53～118 min,平均75 min.术后随访6～36个月,平均12个月.手术前、后肾盂前后径和肾小球滤过率比较差异均有统计学意义(P＜0.05).术后患儿肾盂输尿管吻合口通畅,肾皮质不同程度增厚,脐部伤口瘢痕不明显,美容效果良好. 结论对于年龄小于3个月、由肾盂输尿管连接处梗阻所引起的重度肾积水患儿,经脐多通道腹腔镜下肾盂成形术是一种可行、安全和微创的治疗手段,且美容效果良好.但该手术难度较高,需要术者有丰富的儿童腹腔镜外科手术经验.
목적 개소경제다통도복강경하신우성형술치료소우3개월중도신적수환인적초보경험. 방법 회고성분석2010년6월지2013년3월72례소우3개월적신우수뇨관련접처경조소치중도신적수환인적병례자료.수술시년령7～87 d,평균34 d.수술간예지증:①미국소인비뇨외과학회분급4도;②분신공능점비＜40％.환인균행경제다통도복강경하신우성형술.술후진행수방,수방내용포괄사체、초성검사화핵소검사. 결과 72례수술균획성공,무중전개방자,술중무액외방치투관자,미발생술중병발증.수술시간53～118 min,평균75 min.술후수방6～36개월,평균12개월.수술전、후신우전후경화신소구려과솔비교차이균유통계학의의(P＜0.05).술후환인신우수뇨관문합구통창,신피질불동정도증후,제부상구반흔불명현,미용효과량호. 결론 대우년령소우3개월、유신우수뇨관련접처경조소인기적중도신적수환인,경제다통도복강경하신우성형술시일충가행、안전화미창적치료수단,차미용효과량호.단해수술난도교고,수요술자유봉부적인동복강경외과수술경험.
Objective To present our initial experience of using transumbilical multi-stab laparoscopic pyeloplasty(TMLP) as a treatment for the infants younger than 3 months with severe hydronephrosis caused by ureteropelvic junction obstruction (UPJO).Methods Seventy-two infants younger than 3 months with severe hydronephrosis caused by UPJO underwent TMLP from June 2010 to March 2013 in our center.The average age received operation was 34 days (7-87 days).The operative indications included:① prenatal diagnosis of Society of Fetal Urology Grade 4 hydronephrosis; ②ipsilateral differential renal function being less than 40％.Patients were followed up with physical examinations,ultrasound and radionuclide scans.Results The operations were successfully performed in all the 72 patients.Neither conversion nor additional trocars placement was required and there was no intraoperative complication.The average operative time was 75 min (range,53-118 min).The patients were followed up for 6-36 months (mean,12 months).The renal pelvic anteroposterior diameters were reduced and the renal functions were improved (P＜ 0.05).The anastomoses were proved to be patent and the renal parenchymal thickeness increased.In addition,the scars were barely noticeable.Conclusions TMLP for the infants younger than 3 months with severe hydronephrosis caused by UPJO is feasible,safe and less invasive.The cosmetic results are excellent.But the surgery must be operated by rich experienced surgeon.