腹腔镜手术治疗小儿副肾动脉压迫引起肾积水的临床体会

doi:10.3877/cma.j.issn.1674-3253.2022.01.016

中华腔镜泌尿外科杂志(电子版) ›› 2022, Vol. 16 ›› Issue (01) : 73 -76. doi: 10.3877/cma.j.issn.1674-3253.2022.01.016

临床研究

腹腔镜手术治疗小儿副肾动脉压迫引起肾积水的临床体会

阿布都赛米·阿布都热衣木¹, 王俊¹, 秦双利¹, 玉苏甫·阿克木¹, 叶尔番¹, 和军¹, 李凯¹, 刘东¹, 阿孜古丽¹, 周玲¹, 李水学¹^,^†(

)

^1. 830001　新疆维吾尔自治区儿童医院小儿外科

收稿日期:2020-10-15 出版日期:2022-02-01
通信作者: 李水学
基金资助:
自治区卫生健康青年医学科技人才专项科研项目(WJWY-202117)

Clinical experiences of laparoscopy for children with hydronephrosis caused by compression of accessory renal artery

Abudureyimu Abudusaimi·¹, Jun Wang¹, ShuangLi Qin¹, Akemu Yusufu·¹, Erfan Ye¹, Jun He¹, Kai Li¹, Dong Liu¹, Aziguli¹, Ling Zhou¹, Shuixue Li¹^,^†()

^1. Department of Pediatric Surgery, Children’s Hospital of Xinjiang Uygur Autonomous Region, Urumqi 830001, China

Received:2020-10-15 Published:2022-02-01
Corresponding author: Shuixue Li

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目的

探讨小儿副肾动脉压迫引起肾积水的临床特点及腹腔镜手术治疗的安全性和应用价值。

方法

2017年１月至2019年12月我院收治副肾动脉压迫引起肾积水的患儿13例，男9例，女4例，左侧11例，右侧2例。回顾性分析了副肾动脉压迫引起肾积水患儿的临床资料。

结果

本组13例均证实副肾动脉压迫肾盂输尿管交界处引起肾积水，副肾动脉起源于腹主动脉11例，起源于肾动脉2例。均在腹腔镜下完成离断式肾盂成形术，置入双J管，吻合口周围放置引流管，术后3~ 6 d拔除。手术时间（120±25）min；出血量（6.0±2.5）ml，患儿手术当天全流食。1例术后第2天出现漏尿，经治疗3 d后愈合。住院时间（8.5±0.5）d。术后随访3~15个月，1例肾萎缩者肾功能继续下降，出现完全无功能，反复出现发热、腰痛等泌尿道感染症状，二期行肾切除术，其余患儿无出现肾功能继续下降。

结论

腹腔镜手术治疗小儿副肾动脉压迫引起的肾积水安全，创伤小，术后康复快，具有微创优势。

关键词: 副肾动脉, 儿童, 肾盂输尿管连接部梗阻, 腹腔镜

Objective

To investigate the clinical characteristics of hydronephrosis caused by pediatric accessory renal artery compression and the safety and application value of laparoscopic surgery.

Methods

From January 2017 to December 2019, 13 cases of hydronephrosis caused by accessory renal artery compression were admitted to our hospital, including 9 males, 4 females, 11 on the left side and 2 on the right side. The clinical data were analyzed retrospectively.

Results

All the 13 cases in this group confirmed obstruction of ureteropelvic junction caused by compression of accessory renal artery, which originated from abdominal aorta in 11 cases and renal artery in 2 cases. All of them underwent detach pyeloplasty by laparoscopy. Double J tube was placed. Drainage tube was placed around anastomotic stoma, and removed 3-6 d after operation. The operation time was (120± 25) min. The blood loss was (6.0±2.5) ml. On the day of surgery, the patient was given a full-flow diet. One patient had urinary leakage on the second day after surgery, and was healed after treatment for 3 days. The patients were hospitalized for (8.5±0.5) days. After 3-15 months of follow-up, the renal function of 1 patient with renal atrophy continued to decline, presenting complete dysfunction, recurrent symptoms of fever, lumbago and other urinary tract infections, and nephrectomy was performed in the second stage, while the other of the children did not continue to decline in renal function.

Conclusion

Laparoscopy for hydronephrosis caused by pediatric accessory renal artery compression is safe, with small trauma, quick postoperative recovery and minimally invasion.

Key words: Accessory renal artery, Children, UPJO, Laparoscopy

图6 术后随访3~15个月，腹腔镜手术切口

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Clinical experiences of laparoscopy for children with hydronephrosis caused by compression of accessory renal artery