机器人辅助单孔腹腔镜肾盂成形术在小儿肾盂输尿管连接部梗阻中的应用

doi:10.3877/cma.j.issn.1674-3253.2026.03.007

目的

探讨机器人辅助单孔腹腔镜肾盂成形术（RSLP）治疗小儿肾盂输尿管连接部梗阻（UPJO）的应用价值,并对RSLP治疗UPJO的经验进行初步总结。

方法

收集本中心2024年2月至2025年4月接受RSLP的患儿（年龄≤14岁）的临床资料，分析RSLP治疗UPJO的疗效。

结果

共纳入17例患儿（11例左侧，6例右侧），均顺利完成手术,无中转开腹，无术中并发症发生。患儿中位年龄4.0（2.5，64.0）个月，手术时间（186±43）min，肾盂输尿管吻合时间（73±20） min，中位住院时间6（3，10）d，术后中位住院时间2（1，3）d，中位随访8（3，9）个月。1例（5.8%）患儿因伤口愈合不良返院行清创术，术后愈合良好。术后患儿肾积水分级、肾盂前后径和肾实质厚度显著改善（P均<0.001）。

结论

RSLP应用于小儿UPJO安全、有效。

关键词: 机器人辅助单孔腹腔镜, 肾盂成形术, 小儿, 肾盂输尿管连接部梗阻

Objective

To explore the application value of robot-assisted single-port laparoscopic pyeloplasty (RSLP) in the treatment of ureteropelvic junction obstruction (UPJO) in children and to preliminarily summarize experiences with RSLP in the treatment of UPJO.

Methods

The clinical data of children (≤14 years old) who underwent RSLP at our center from February 2024 to April 2025 were collected, and the efficacy of RSLP in the treatment of UPJO was analyzed.

Results

A total of 17 children (11 on the left side, 6 on the right side) were included, and all surgeries were successfully completed without conversion to open surgery or intraoperative complications. The median age of the children was 4.0(2.5, 64.0) months, the operation time was (186±43) min, the anastomosis time of the renal pelvis and ureter was (73±20) min, the median hospital stay was 6(3, 10) d, the median postoperative hospital stay was 2(1, 3) d, and the median follow-up was 8(3, 9) months. One child (5.8%) returned to the hospital for debridement due to poor wound healing and recovered well after surgery. The hydronephrosis grade, anteroposterior diameter of the renal pelvis, and renal parenchyma thickness of children were significantly improved after surgery.

Conclusion

RSLP is safe and effective for the treatment of UPJO in children.

Key words: Robot-assisted single-port laparoscopic, Pyeloplasty, Pediatric, Ureteropelvic junction obstruction

图1 单孔腹腔镜安装步骤注：a为置入内环，b为四通道腹腔镜单孔穿刺器，c为机器对接

图2 机器人单孔腹腔镜治疗肾盂输尿管连接部梗阻（UPJO）关键步骤注：a为4点悬吊肾盂及输尿管，b为缝合吻合口后壁，c为缝合吻合口前壁，d为关闭肾周筋膜口，e为术后脐部伤口

图3 UPJO患儿术后2个月脐部伤口

表1 17例UPJO患儿手术前后肾积水情况对比

组别	SFU分级(例)					肾盂前后径[mm，(±s)]	肾实质厚度[mm，(±s)]
组别	0	1	2	3	4	肾盂前后径[mm，(±s)]	肾实质厚度[mm，(±s)]
术前	0	0	0	5	12	31±10	4.9±2.9
术后	1	4	2	8	2	13±8	7.8±2.7
统计值	Z=-4.536					t=5.141	t=-4.487
P值	<0.001					<0.001	<0.001

表1 17例UPJO患儿手术前后肾积水情况对比

组别	SFU分级(例)					肾盂前后径[mm，(±s)]	肾实质厚度[mm，(±s)]
组别	0	1	2	3	4	肾盂前后径[mm，(±s)]	肾实质厚度[mm，(±s)]
术前	0	0	0	5	12	31±10	4.9±2.9
术后	1	4	2	8	2	13±8	7.8±2.7
统计值	Z=-4.536					t=5.141	t=-4.487
P值	<0.001					<0.001	<0.001

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Application of robot-assisted single-port laparoscopic pyeloplasty in children with ureteropelvic junction obstruction

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Application of robot-assisted single-port laparoscopic pyeloplasty in children with ureteropelvic junction obstruction