临床小儿外科杂志2024，Vol.23Issue(9)：850-856,7.DOI:10.3760/cma.j.cn101785-202401001-009
机器人辅助单孔腹腔镜手术在儿童重复肾治疗中的探索
Exploration of robot assisted laparoscopic single-port surgery in children with duplex kidney
摘要
Abstract
Objective To explore the applications and efficacy of Ⅳ generation Da Vinci(Ⅺ)robot assisted single-port laparoscopy in children of duplex kidney(DK).Methods From June 2020 to June 2023,the relevant clinical data were retrospectively reviewed for 10 DK girls undergoing robot assisted single port lap-aroscopy.Age range was(0.75-83)month.The clinical manifestations included fever(n=5),urinary tract infections(n=7),urethral discharge(n=2)and abdominal pain(n=3).Preoperative examinations of ultra-sonography,magnetic resonance urography(MRU)and computed tomography urography(CTU)were per-formed.Diethyltriamine pentaacetic acid(DTPA)imaging(n=8)and voiding cystourethrography(VCUG,n=3)were conducted.There were renal function ≤ 10％(n=2),underdeveloped kidney(n=2)and recurrent upper group hydronephrosis(n=1).The procedures included ureteroureterostomy(n=5),heminephrectomy(n=2),ureterovesical reimplantation(n=2)and pyeloplasty(n=1).Results All procedures were per-formed under robot assisted single port laparoscopy without any conversion into open surgery.For ureteroureter-ostomy,mean operative duration was(134.4±24.8)min and mean hospitalization stay(7±2.7)day;for heminephrectomy,mean operative duration was(162.5±53)min and mean hospitalization stay(7.5±0.7)day;for ureterovesical reimplantation,mean operative duration was(114.5±21.9)min and mean hospitaliza-tion stay(5.5±0.7)day;for pyeloplasty,mean operative duration was 141 min and mean hospitalization stay 6 days.Doppler ultrasonography and urinary routine/culture were regularly rechecked postoperatively to observe whether or not there was an onset of ureteral dilation/stenosis,ureteral reflux or urinary tract infections.The fol-low-up period was(6-42)month.One case of postoperative anastomotic fistula improved after proper anti-in-fection and sufficient drainage.Another case of urinary tract infection with fever disappeared after antibiotic do-sing.One child of ureteral bladder replantation was diagnosed with grade Ⅱ VUR by ureterography under B-ul-trasonic guidance at Year 2 post-operation.Without urinary tract infection,no special treatment was given.Conclusions Single-port robotic surgery is both safe and feasible.However,there are strict requirements for co-operations and operational skills of teams such as surgeons,assistants,anesthesiologists and nurses.After anes-thesia,a proper body position shall facilitate intraoperative handling and reduce operative duration.Surgical scar is hidden in navel and parents are satisfied with the postoperative appearance of scar.关键词
重复肾/机器人手术/腹腔镜检查/肾切除术Key words
Duplex Kidney/Robotic Surgical Procedures/Laparoscopy/Nephrectomy引用本文复制引用
郭云凯,骆明双,高贺云,张文,宋学敏,赵国艳,余山桢,胡涛,李庚,杜国伟..机器人辅助单孔腹腔镜手术在儿童重复肾治疗中的探索[J].临床小儿外科杂志,2024,23(9):850-856,7.基金项目
武汉大学中南医院学科能力建设项目(YYXKNLJS2024020) Discipline Capacity Building Project of Zhongnan Hospital of Wuhan University(YYX-KNLJS2024020) （YYXKNLJS2024020）
