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目的:探讨耻骨上辅助经脐单孔腹腔镜技术(SA-LESS)在小儿重复肾畸形治疗中的应用价值。方法:本组9例,男3例,女6例,中位年龄9(2~15)岁。左侧5例,右侧4例。包括重复肾输尿管畸形4例,重复肾并巨输尿管积脓1例,重复肾并重复输尿管异位开口2例,重复肾并重复输尿管囊肿2例。均施行SA-LESS重复肾切除术。记录手术时间、术中出血量、术后住院时间、术中和术后并发症及随访情况。结果:9例手术均成功,术中、术后未出现肠管、实质性器官和大血管损伤以及肠梗阻等并发症。中位手术时间81(60~130)min;术中中位失血量35(10~50)ml,均未输血;术后中位住院时间7.5(7~10)d。随访2~43个月,脐部穿刺孔及耻骨上切口均愈合良好,脐部瘢痕不明显,均无切口疝发生。彩超及肾ECT提示患侧下半肾功能良好,无肾周尿囊肿形成。结论:SA-LESS小儿重复肾切除术安全可行,具有创伤小、美容效果佳、手术难度和风险相对较低、手术时间短等优势,值得临床应用。
Objective: To investigate the clinical value of suprapubic assisted transthoracic single-hole laparoscopy (SA-LESS) in the treatment of children with recurrent renal deformity. Methods: The group of 9 patients, 3 males and 6 females, the median age of 9 (2 to 15) years old. 5 cases on the left and 4 cases on the right. Including repeated renal ureter malformation in 4 cases, repeated renal and giant ureter empyema in 1 case, repeat the kidney and repeat ureteral ectopic opening in 2 cases, repeat the kidney and repeat ureteral cyst in 2 cases. All patients underwent SA-LESS repeat nephrectomy. The operation time, intraoperative blood loss, postoperative hospital stay, intraoperative and postoperative complications and follow-up were recorded. Results: All of the 9 cases were successful. No complications such as bowel, substantial organ injury, macrovascular injury and intestinal obstruction occurred during and after operation. The median operative time was 81 (60-130) min. The median intraoperative blood loss was 35 (10-50) ml, with no blood transfusion. The median postoperative hospital stay was 7.5 (7-10) days. Follow-up 2 to 43 months, umbilical puncture and suprapubic incision healed well, umbilical scar was not obvious, no incision hernia occurred. Color ultrasound and renal ECT prompted the affected side of the lower half of the kidney is good, no perirenal cyst formation. Conclusions: SA-LESS pediatric nephrectomy is safe and feasible. It has the advantages of small trauma, good cosmetic effect, relatively low difficulty and risk of operation, short operative time and so on, which is worthy of clinical application.