Laparoscopic Surgery on Upper Urinary Tract in Children Younger Than 1 Year: Technical Aspects and Functional Outcome
Laparoscopic Surgery on Upper Urinary Tract in Children Younger Than 1 Year: Technical Aspects and Functional Outcome
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DOI：
10.1016/j.juro.2009.06.063
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发表时间：
2009-10-01
影响因子：
6.6
通讯作者：
Szavay, P.
中科院分区：
文献类型：
--
作者：
Fuchs, J.;Luithle, T.;Szavay, P.
目的：微创手术在小儿泌尿外科中越来越重要。然而，经验仍然是有限的微创手术的婴儿上尿路。我们分析了3种微创手术，（肾盂成形术、半肾输尿管切除术和肾切除术）。材料和方法：我们分析了67名儿童（平均+/- SD年龄5.1 +/- 2.9个月）接受微创肾盂成形术的26例患者（第1组），半肾输尿管切除术18例（第2组），肾切除术23例（第3组）。对第1组和第2组的术前和术后超声和巯基乙酰三甘氨酸肾扫描进行统计学评价。结果：平均SD患者体重为6.4 ± 1.8 kg，平均+/- SD手术时间为113.2 ± 41.6分钟。1例肾盂成形术中转开放手术。发生1例并发症（术中肠穿孔漏诊）。所有患儿均无需输血。肾盂成形术后，所有患者的示踪剂清除率（巯基乙酰三甘氨酸扫描）和肾盂形态（超声）均有所改善。在第1组和第2组中，术前和术后受影响肾脏的部分功能之间没有统计学差异。平均+/- SD随访时间为32.5 +/- 19.8 months.Conclusions：1岁以下儿童上尿路微创手术在技术上具有挑战性，需要外科医生和整个团队的专业知识。鉴于这些假设，此类手术可以安全进行，功能结局良好。
Purpose: Minimally invasive procedures are increasingly important in pediatric urology. However, experience is still limited with minimally invasive operations on the upper urinary tract in infants. We analyzed 3 minimally invasive procedures (pyeloplasty, heminephroureterectomy and nephrectomy) in children younger than 1 year.Materials and Methods: We analyzed 67 children (mean +/- SD age 5.1 +/- 2.9 months) undergoing minimally invasive pyeloplasty in 26 patients (group 1), heminephroureterectomy in 18 (group 2) or nephrectomy in 23 (group 3) with regard to technical aspects, surgical outcome and complications. Preoperative and postoperative ultrasound and mercaptoacetyltriglycine renal scan were statistically evaluated in groups 1 and 2.Results: Mean SD patient weight was 6.4 +/- 1.8 kg and mean +/- SD operative time was 113.2 +/- 41.6 minutes. Conversion to open surgery was necessary in 1 pyeloplasty. One complication (missed intraoperative bowel perforation) occurred. No blood transfusion was required in any child. After pyeloplasty there were improved tracer clearances (mercaptoacetyltriglycine scan) and improved morphologies of the pyelon (ultrasound) in all patients. In groups 1 and 2 there was no statistical difference between preoperative and postoperative partial function of the affected kidney. Mean +/- SD followup was 32.5 +/- 19.8 months.Conclusions: Minimally invasive procedures on the upper urinary tract in children younger than 1 year are technically challenging, and require expertise of the surgeon and the entire team. Given these assumptions, such procedures can be safely performed with excellent functional outcomes.