[1]王双双王晓晖**张书峰高建王霖史若乂孙英豪.机器人辅助腹腔镜肾盂成形术治疗≤6月龄小婴儿肾积水44例[J].中国微创外科杂志,2025,01(2):87-91.
　Wang Shuangshuang,Wang Xiaohui,Zhang Shufeng,et al.Robotassisted Laparoscopic Pyeloplasty for 44 Cases of Hydronephrosis in Infants Younger Than 6 Months Old[J].Chinese Journal of Minimally Invasive Surgery,2025,01(2):87-91.
点击复制

机器人辅助腹腔镜肾盂成形术治疗≤6月龄小婴儿肾积水44例()
分享到：

《中国微创外科杂志》[ISSN:1009-6604/CN:11-4526/R]

卷:
01
期数:
2025年2期
页码:
87-91
栏目:
临床研究
出版日期:
2025-02-25

文章信息/Info

Title:
Robotassisted Laparoscopic Pyeloplasty for 44 Cases of Hydronephrosis in Infants Younger Than 6 Months Old
作者:
王双双王晓晖**张书峰高建王霖史若乂孙英豪
(郑州大学人民医院河南省人民医院小儿外科，郑州450003)
Author(s):
Wang Shuangshuang;  Wang Xiaohui;  Zhang Shufeng;  et al.
Department of Pediatric Surgery, People’s Hospital of Zhengzhou University, Henan Provincial People’s Hospital,Zhengzhou 450003, China
关键词:
机器人辅助腹腔镜肾盂成形术; 婴儿; 肾积水; 肾盂输尿管连接部梗阻
Keywords:
Robotassisted laparoscopic pyeloplasty; Infant; Hydronephrosis; Ureteropelvic junction obstruction
文献标志码:
A
摘要:
目的探讨机器人辅助腹腔镜肾盂成形术(robotassisted laparoscopic pyeloplasty，RALP)治疗≤6月龄小婴儿肾盂输尿管连接部梗阻(ureteropelvic junction obstruction，UPJO)肾积水的疗效及安全性。方法回顾性分析2021年1月~2023年12月RALP治疗44例≤6月龄小婴儿UPJO肾积水的临床资料。年龄5天~6个月，(72.3±49.7)天；体重2.9~8.5 kg，(5.7±1.6)kg。术前彩超检查肾盂前后径(anteroposterior diameter，APD)(30.2±9.5)mm，肾实质最薄处厚度(2.6±1.2)mm。使用达芬奇Xi机器人手术系统，充分暴露肾盂输尿管连接部狭窄段，剪刀修剪肾盂及输尿管，60单股线吻合肾盂输尿管。结果44例手术均顺利完成，无中转传统腹腔镜或开放手术，无术中并发症。手术时间105~245 min，平均1798 min，术中出血量2~10 ml，平均4.9 ml。拔除双J管后6个月复查彩超，APD(10.5±6.3)mm，较术前显著减小(配对t检验，t=19985，P=0.000)，肾实质最薄处厚度(6.8±1.7)mm，较术前显著增加(配对t检验，t=18.420，P=0.000)。拔除双J管后随访6~12个月，无吻合口狭窄、漏尿、再次梗阻。结论RALP治疗≤6月龄小婴儿UPJO肾积水安全有效。
Abstract:
ObjectiveTo evaluate the efficacy and safety of robotassisted laparoscopic pyeloplasty (RALP) in the treatment of obstructive hydronephrosis at ureteropelvic junction in infants ≤ 6 months old.MethodsClinical data of 44 infants with ureteropelvic junction obstruction (UPJO) and hydronephrosis treated by RALP from January 2021 to December 2023 were analyzed retrospectively. The average age was (72.3±49.7) d (range, 5 d-6 months old), and the average weight was (5.7±1.6) kg (range, 2.9-8.5 kg). Preoperative ultrasonography showed that the anteroposterior diameter was (30.2±9.5) mm and the thinnest part of the renal parenchyma was (2.6±1.2) mm. By using the da Vinci Xi robotic operating system, the narrow segment of the ureteropelvic junction was fully exposed, the renal pelvis and ureter were trimmed with scissors, and the ureter was anastomosed with 60 single strands.ResultsAll the 44 operations were completed successfully without conversion to traditional laparoscopic or open surgery. No intraoperative complications occurred. The operation time was 105-245 min (mean, 179.8 min), and the intraoperative blood loss was 2-10 ml (mean, 4.9 ml). Reexaminations of ultrasonography at 6 months after removal of double J tube showed that the anteroposterior diameter was (10.5±6.3) mm, which was significantly decreased than that before operation (paired t test, t=19985, P=0.000), and the thinnest part of the renal parenchyma was (6.8±1.7) mm, which was significantly increased than that before operation (paired t test, t=18.420, P=0.000). The patients were followed up for 6-12 months after removal of double J tube. There were no complications such as anastomotic stricture, urine leakage, or recurrence of obstruction.ConclusionRALP is safe and effective in the treatment of UPJO and hydronephrosis in infants younger than 6 months old.

参考文献/References:

[1] Ficara A, Syngelaki A, Hammami A, et al. Value of routine ultrasound examination at 35-37 weeks’ gestation in diagnosis of fetal abnormalities. Ultrasound Obstet Gynecol, 2020, 55(1):75-80.
[2] 徐新茹, 陈江龙, 林珊, 等. 机器人辅助单孔加一孔腹腔镜肾盂成形术在儿童UPJO中的疗效分析. 中华泌尿外科杂志, 2023, 44(7):524-528.
[3] 李泸平, 张俊杰, 张胜利, 等. 机器人辅助腹腔镜与传统腹腔镜在儿童肾盂成形术的应用价值. 中华小儿外科杂志, 2022, 43(1):14-19.
[4] Andolfi C, Adamic B, Oommen J, et al. Robot-assisted laparoscopic pyeloplasty in infants and children: is it superior to conventional laparoscopy. World J Urol, 2020, 38(8):1827-1833.
[5] 何雨竹, 倪鑫, 张潍平. 儿童先天性肾盂输尿管连接部梗阻性肾积水手术治疗策略研究进展. 临床外科杂志, 2021, 29(6):501-504.
[6] Gettman MT, Neururer R, Bartsch G, et al. Anderson-Hynes dismembered pyeloplasty performed using the da Vinci robotic system. Urology, 2002, 60(3):509-513.
[7] Fuchs ME, DaJusta DG. Robotics in pediatric urology. Int Braz J Urol, 2020, 46(3):322-327.
[8] 中华医学会小儿外科分会泌尿外科学组. 先天性肾盂输尿管交界处梗阻诊疗专家共识. 中华小儿外科杂志, 2018, 39(11):804-810.
[9] 刘德鸿, 周辉霞, 马立飞, 等. 机器人辅助腹腔镜肾盂成形术治疗小婴儿肾积水的初步经验. 中华泌尿外科杂志, 2019, 40(1):2-7.
[10] Kafka IZ, Kocherov S, Jaber J, et al. Pediatric robotic-assisted laparoscopic pyeloplasty (RALP): does weight matter? Pediatr Surg Int, 2019, 35(3):391-396.
[11] Wong YS, Pang KKY, Tam YH. Comparing robot-assisted laparoscopic pyeloplasty vs. laparoscopic pyeloplasty in infants aged 12 months or less. Front Pediatr, 2021, 9:647139.
[12] Badawy H, Saad A, Fahmy A, et al. Prospective evaluation of retroperitoneal laparoscopic pyeloplasty in children in the first 2 years of life: is age a risk factor for conversion. J Pediatr Urol, 2017, 13(5):511.e1-511.e4.
[13] He Y, Song H, Liu P, et al. Primary laparoscopic pyeloplasty in children: a single-center experience of 279 patients and analysis of possible factors affecting complications. J Pediatr Urol, 2020, 16(3): 331.e1-331.e11.
[14] Arena S, Chimenz R, Antonelli E, et al. A long-term follow-up in conservative management of unilateral ureteropelvic junction obstruction with poor drainage and good renal function. Eur J Pediatr, 2018, 177(12):1761-1765.
[15] Subramaniam R, Kouriefs C, Dickson AP. Antenatally detected pelvi-ureteric junction obstruction: concerns about conservative management. BJU Int, 1999, 84(3):335-338.
[16] Jiang D, Tang B, Xu M, et al. Functional and morphological outcomes of pyeloplasty at different ages in prenatally diagnosed Society of Fetal Urology grades 3-4 ureteropelvic junction obstruction: is it safe to wait? Urology, 2017, 101:45-49.
[17] Chandrasekharam VVS, Babu R, Arlikar J, et al. Functional outcomes of pediatric laparoscopic pyeloplasty: post-operative functional recovery is superior in infants compared to older children. Pediatr Surg Int, 2021, 37(8):1135-1139.
[18] Radulovi? M, Pucar D, Jaukovi? L, et al. Diuretic ???Tc DTPA renography in assessment of renal function and drainage in infants with antenatally detected hydronephrosis. Vojnosanit Pregl, 2015, 72(12):1080-1084.
[19] 罗添华, 张旭辉, 赵德善, 等. 肾动态显像在婴儿重度肾积水治疗决策中的应用. 中华核医学与分子影像杂志, 2023, 43(5):281-285.
[20] 熊祥华, 周辉霞, 曹华林, 等. 机器人辅助腹腔镜小儿上尿路手术的体位、操作通道设计和机械臂安装应用体会. 中华泌尿外科杂志, 2018, 39(8):601-605.
[21] 王林辉, 吴震杰, 朱清毅. 中国泌尿外科单孔腹腔镜技术的发展与展望. 中华泌尿外科杂志, 2020, 41(11):807-810.
[22] 高建, 张书峰, 王晓晖, 等. 机器人辅助腹腔镜肾盂成形术在儿童肾盂输尿管连接部梗阻中的应用. 中国微创外科杂志, 2022, 22(6):454-458.

备注/Memo

备注/Memo:
基金项目：河南省科技攻关项目(222102310133)**通讯作者，Email：7655100@qq.com
更新日期/Last Update: 2025-04-29