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目的探讨经脐腹腔镜肾盂成形术治疗3个月以下婴儿重度肾积水的可行性及安全性。方法回顾性分析自2011年6月至2014年6月,我科收治的3个月以下婴儿重度肾积水患儿135例的临床资料。其中,男性96例,女性39例,均由产前超声检查检出,肾盂前后径均>3.0 cm,出生后经超声及磁共振水成像(MRU)证实,放射性核素扫描(ECT)患侧分肾肾小球滤过率(GFR)均<40 ml/min。采用经脐单孔(72例)及多孔(63例)入路腹腔镜离断式肾盂成形术。结果全部患儿手术过程均顺利,无中转开放或另外增加Trocar,未出现围术期并发症。手术平均时间(81.25±14.32)min,术中平均出血量(7.75±4.0)ml,术后平均住院时间(7.22±1.09)d。随访3~36个月,127例患肾肾实质均有不同程度增厚,肾盂前后径均明显减小,患肾分肾功能不同程度恢复。4例术后肾积水稳定,未见加重,另外4例术后再次狭窄行二次手术好转。结论经脐腹腔镜肾盂成形术治疗婴儿重度肾积水安全可行,效果确切,美容效果良好。
Objective To investigate the feasibility and safety of transvaginal laparoscopic pyeloplasty for severe hydronephrosis in infants under 3 months. Methods The clinical data of 135 infants with severe hydronephrosis below 3 months admitted from June 2011 to June 2014 were retrospectively analyzed. Among them, 96 males and 39 females were detected by prenatal ultrasound examination. The anteroposterior diameter of renal pelvis was> 3.0 cm. After birth, ultrasound and MRU confirmed that radionuclide scan (ECT) Renal glomerular filtration rate (GFR) <40 ml / min. Laparoscopic pyeloplasty was performed using transumbilical single hole (n = 72) and porous (n = 63). Results All patients underwent a successful surgical procedure without any transit or additional Trocar. No perioperative complications occurred. The mean operative time (81.25 ± 14.32) min, mean intraoperative blood loss (7.75 ± 4.0) ml and postoperative average length of stay (7.22 ± 1.09) d respectively. All cases were followed up for 3 ~ 36 months. 127 cases had thickening of renal parenchyma in varying degrees, and the anteroposterior diameter of renal pelvis was significantly reduced. The renal function of kidney was recovered to varying degrees. 4 cases of postoperative hydronephrosis was stable, no increase in the other 4 cases of stenosis again surgery after the second surgery improved. Conclusion Umbilical laparoscopic pyeloplasty for the treatment of severe hydronephrosis in infants is safe and feasible, the effect is exact and the cosmetic effect is good.