小儿后腹腔镜肾切除与肾部分切除术临床分析.docVIP

小儿后腹腔镜肾切除与肾部分切除术临床分析 　　摘要：目的 评价后腹腔镜肾切除术和部分切除术在小儿患者中的安全性和有效性。方法 回顾性分析2011年～2014年于我院住院的40例小儿肾疾病需行后腹腔镜肾切除或肾部分切除术患者，分析患者的一般资料、手术时间、手术并发症并与开放手术相关资料对比。结果 40例患儿中，共实施了30例肾切除和10例肾部分切除术。患者平均年龄84月（7～175月）。病变多以先天性疾病为主如膀胱输尿管返流，UPJ、多囊性肾疾病。平均总手术时间约158 min（60～280 min），其中肾部分切除术手术时间平均为150 min，肾切除手术时间为70 min，无术中并发症发生，包括手术并发症及麻醉并发症。无明显出血需输血患者，无术后并发症发生。平均术后住院时间为5 d。引流管拔除时间为平均为术后第2 d。结论 后腹腔镜肾切除术及肾部分切除术治疗小儿肾脏疾病是安全有效的。 　　关键词：小儿；后腹腔镜；肾切除术；肾部分切除术 　　Abstract：Objective The aim was to evaluate our experience in the retroperitoneal laparoscopic approach in total and partial nephrectomies in children.Methods We retrospectively reviewed the medical records of 40 patients who underwent retroperitoneal laparoscopic total or partial nephrectomies performed in our center from 2011 to 2014. We looked at the demographic data， age at surgery， indication， operative time， surgical complications， conversion to open surgery and operative complications.Results 30 total and 10 partial nephrectomies were performed. The mean age was 84 months （7～175Months）. Vesicoureteric reflux， pelviureteric junction obstruction， and multicystic dysplastic kidney disease were the main underlying pathologies.The mean operative time was 158min（60～280min）. There were no intraoperative complications （surgical and anesthetic）， and no significant blood loss was observed. Conversion to open surgery was necessary in two cases caused by failure to progress due to difficult anatomy during the partial nephrectomies. No major postoperative complications were noted. The mean hospital stay was 5days （1～8）. A drain was used in all cases and was removed after a mean of 2 days.Conclusion Laparoscopic retroperitoneoscopic renal surgery can be carried out safely and effectively in children. 　　Key words：Children；Laparoscopy；Nephrectomy；Partial nephrectomy；Retroperitoneal 　　近年?恚?，泌尿外科微创手术因其切口小、疼痛小、恢复快、住院时间短等优点[1-3]在临床中的应用越来越广泛。在小儿泌尿外科领域越来越重视，小儿肾脏疾病的腹腔镜手术可以通过腹腔途径也可以经过腹膜外途径[4]。两种手术入路各有优缺点，经腹腔途径手术操作空间大，解剖标志清晰。而经腹膜后途径手术更具挑战性，因为操作空间小并且无解剖标志，但是手术中