腹腔镜阑尾补片技术修复儿童肾盂成形术后再狭窄的临床应用
Clinical application of laparoscopic appendiceal onlay flap technique for restenosis after pyeloplasty in children
陶天 1曹华林 2赵晓波 3周辉霞 4李品 4赵扬4
作者信息
- 1. 华北理工大学附属唐山市妇幼保健院小儿外科,唐山 063003;解放军总医院第七医学中心儿科医学部儿童泌尿外科,北京 100700
- 2. 广西壮族自治区南溪山医院泌尿外科,桂林 541002
- 3. 华北理工大学附属唐山市妇幼保健院小儿外科,唐山 063003
- 4. 解放军总医院第七医学中心儿科医学部儿童泌尿外科,北京 100700
- 折叠
摘要
目的:探讨腹腔镜阑尾补片技术修复儿童肾盂成形术后再狭窄的可行性.方法:回顾性分析唐山市妇幼保健院、解放军总医院第七医学中心自2017年10月至2023年2月13例行阑尾补片技术修复肾盂成形术后再狭窄患者的临床资料,其中男 9例,女 4例,病变均为右侧,平均年龄 7.8(3.5～15.3)岁.所有患者术前均行泌尿系B超,磁共振泌尿系水成像及利尿性肾核素显像等检查明确诊断.采用带蒂阑尾补片镶嵌输尿管技术修复长段输尿管狭窄,术后并发症采用Clavien-Dindo进行评估.结果:所有手术均在腹腔镜下完成,无中转开放手术.平均输尿管狭窄长度3.2(2.5～4.3)cm,平均手术时间 182.0(150～250)min,术中平均出血量 34.8(18～45)ml,术后平均引流管留置时间 5.6(3～8)d,术后平均住院时间 10.8(7～15)d.术后Clavien-Dindo Ⅲ级并发症发生率为23.1%,3例患者术后出现双J管堵塞,行双J管更换后好转,2例患者术后出现吻合口漏尿,予以保持尿管引流通畅并延长腹腔引流管留置时间后好转,无Clavien-Dindo IV级并发症.所有患者术后2个月取出支架管时行输尿管镜检查术,术中探查见吻合口愈合良好,管腔通畅,无肠黏液及结石形成,术后泌尿系超声提示积水较术前减少,利尿性肾动态显像提示上尿路引流无梗阻,平均随访 22(12～36)个月,手术成功率100%.结论:腹腔镜阑尾补片镶嵌输尿管成形术治疗儿童右侧肾盂成形术后再狭窄安全可行,是治疗右侧输尿管长段狭窄的较好选择.
Abstract
Objective:To explore the feasibility of laparoscopic appendiceal onlayflap technique for repairing re-stenosis after pyeloplasty in children.Method:The clinical data of patients with restenosis who underwent pyeloplas-ty using the appendiceal onlay flap technique at Tangshan Maternal and Child Health Hospital and the Seventh Medi-cal Center of PLA General Hospital from October 2017 to February 2023 were retrospectively analyzed.There were a total of 9 male and 4 female patients,all presenting lesions on the right side,with an average age of 7.8(3.5-15.3)years.All patients underwent urinary ultrasound,magnetic resonance urography,and diuretic nephrolinoscintigraphy for evaluation purposes.The pedicled appendix onlay flap technique was employed for repairing long ureteral stric-tures.Postoperative complications were assessed utilizing the Clavien Dindo classification system.Result:All opera-tions were performed laparoscopically without any conversions to open surgery.The mean length of ureteral stenosis was 3.2 cm(2.5-4.3 cm),the average operative time was 182.0 minutes(150-250 min),the mean intraoperative blood loss was 34.8 ml(18-45 ml),the average duration of postoperative catheter retention was 5.6 days(3-8 d),and the mean length of postoperative hospital stay was 10.8 days(7-15 d).The incidence of Clavien-Dindo grade III complications was observed in 23.1%of cases,with three patients experiencing double J tube blockage after surgery,which improved following replacement;two patients had anastomotic leakage after surgery,which improved with continued drainage and extended indwelling time for abdominal drainage tube,without any Clavien-Dindo grade IV complications occurring.Ureteroscopy was performed on all patients when stent tubes were removed two months after the operation,revealing good anastomotic healing,unobstructed lumen,and no presence of intestinal mucus or stone formation during intraoperative exploration.Postoperative urinary ultrasound indicated reduced hydronephrosis com-pared to pre-operation levels,while diuretic renal dynamic imaging showed no upper urinary tract drainage obstruc-tion.The average follow-up period lasted for a duration of twenty-two months(12-36 months)with a surgical success rate reaching one hundred percent.Conclusion:The laparoscopic appendiceal onlay flap ureteroplasty represents a safe and feasible therapeutic option for managing complex right ureteral strictures in pediatric patients,thus making it an advantageous choice for addressing extensive right ureteral strictures.
关键词
儿童/腹腔镜/肾盂输尿管成形/阑尾补片/输尿管狭窄Key words
children/laparoscopes/pyeloplasty/appendiceal onlay flap/ureteral stricture引用本文复制引用
出版年
2024
NETL
NSTL
万方数据