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目的:初步探讨对青少年儿童患者行经脐单孔腹腔镜肾盂离断成型术的手术方法及临床疗效。方法:本组3例,均为女性,平均年龄10岁。术前诊断均为左肾盂输尿管结合部梗阻伴重度积水。插管全麻,患侧抬高70°斜卧位,取脐皱褶患侧缘“∩”形切口约2.5cm,经此切口进入腹腔后,置入自制“1环1套3通道”装置,置入30°腹腔镜及普通腹腔镜器械,气腹压力≤1.33kPa(10mm Hg)。经结肠旁沟入路行肾盂离断成型术。结果:3例均成功完成手术,手术时间分别为218、188、205min;术后2d拔出伤口引流后,3d出院,均未发生围术期严重并发症;术后4~6周拔除双J管后,静脉肾盂造影或泌尿系CT平扫+三维重建检查均显示,肾盂漏斗形态完美,吻合口通畅,温哥华瘢痕评分,分别为2、3、3分,脐部瘢痕不明显。结论:用自制“1环1套3通道”装置及普通腹腔镜器械,对青少年儿童患者行经脐单孔腹腔镜肾盂离断成型术,技术可行,伤口美观,但手术技术要求高,仍有较大改良空间。
Objective: To investigate the operation and clinical efficacy of single-hole laparoscopic pyeloplasty in adolescent children. Methods: This group of 3 patients, all female, with an average age of 10 years. Preoperative diagnosis of the left renal pelvis and ureter obstruction with severe hydronephrosis. Intubation general anesthesia, ipsilateral elevation of 70 ° oblique position, take umbilical folds of the edge “∩ ” shaped incision about 2.5cm, after this incision into the abdominal cavity, into homemade “1 ring 1 set 3 Channel ”device, into the laparoscopic 30 ° and ordinary laparoscopic instruments, pneumoperitoneum pressure ≤ 1.33 kPa (10mm Hg). Adjacent colonic canal line renal pelvis fracture surgery. Results: All of the three cases were successfully performed. The operative time was 218, 188 and 205 minutes respectively. No serious complications occurred during the two days after the wounds were drained and the drafts were discharged after 3 days. After the tube, intravenous pyelography or urinary CT scan + 3D reconstruction examination showed that peritoneal funnel morphology is perfect, anastomotic patency, Vancouver scars, respectively, 2,3,3 points, umbilical scar was not obvious. Conclusion: The self-made “1 ring 1 set of 3 channels” device and ordinary laparoscopic instruments, adolescent children through the umbilical single hole laparoscopic pyeloplasty, feasible, good wound, but the technical requirements of surgery is still high There is a lot of room for improvement.