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目的探讨腹腔镜手术在儿童泌尿生殖系统疾病中应用的适应证和手术技巧,分析中转开放手术和术后并发症的原因。方法回顾性分析2006年9月-2010年3月通过腹腔镜手术治疗的儿童泌尿生殖系统疾病276例。男256例,女12例,两性畸形8例;年龄6个月～17岁,平均5岁1个月。其中鞘状突高位结扎152例,腹腔型隐睾下降固定62例,精索静脉曲张高位结扎28例,两性畸形性腺探查8例,发育不良异位肾切除7例,气膀胱输尿管再植、肾盂离断式成型各4例,重肾重输尿管切除3例,肾盂切开结石、肾囊肿去顶减压、卵巢肿瘤切除各2例,发育不全原位肾切除、肾上腺肿瘤切除各1例。结果本组共涉及12种泌尿生殖系统疾病。腹腔镜完成手术268例,中转开放手术8例。全组术后并发症6例,其中Trocar穿刺损伤膀胱、鞘膜积液术后复发、精索静脉曲张术后复发各1例,肾脏手术后尿外渗3例。结论绝大部分儿童泌尿生殖系统疾病均可通过腹腔镜手术安全、有效地完成,但应注意具体病例的适应证选择。
Objective To investigate the indications and surgical techniques of laparoscopic surgery in children with genitourinary system diseases and to analyze the causes of the open surgery and postoperative complications. Methods A retrospective analysis of 276 cases of urinary and reproductive system diseases in children undergoing laparoscopic surgery from September 2006 to March 2010 was retrospectively analyzed. 256 males and 12 females, 8 males and 8 males; aged 6 months to 17 years old, with an average of 5 years and 1 month. 152 cases of high ligation of the sheath-like ligation, peritoneal cryptorchidism decreased fixed in 62 cases, 28 cases of varicocele ligation of high, genital amputation in 8 cases, hypoplastic ectopic resection in 7 cases, bladder vesicoureteral replantation, renal pelvis There were 4 cases in each group, 2 cases in each group, 4 cases in each group, 3 cases in severe renal retransplantation, 7 cases in pyelolithotomy, 7 cases in renal cysts, 2 cases in ovarian tumor resection, 1 case in hypoplastic hypoplastic kidney and 1 case in adrenalectomy. Results The group involved a total of 12 kinds of genitourinary diseases. Laparoscopic surgery completed 268 cases, 8 cases of open surgery. The postoperative complications in 6 cases, including Trocar puncture injury bladder, hydrocele recurrence, varicocele recurrence in 1 case, 3 cases of postoperative urinary osmosis. Conclusion Most of the children with genitourinary diseases can be safely and effectively completed by laparoscopic surgery, but should pay attention to the choice of indications for specific cases.