Kutikov Alexander, Nguyen Michael, Guzzo Thomas, Canter Daniel, Casale Pasquale
Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, Pennsylvania 19107, USA.
J Endourol. 2007 Jun;21(6):621-4. doi: 10.1089/end.2006.0227.
We suggest that when surgical correction is considered to treat a duplicated collecting system with well-functioning moieties, a laparoscopic approach at the renal level is feasible even in cases requiring complex reconstruction.
Six children between the ages of 4 months and 10 years (mean age 5.2 years) presented with urinary-tract infection, incontinence, or pain and underwent transperitoneal laparoscopic reconstruction for duplex collecting system pathology in renal moieties with preserved function. Five patients underwent laparoscopic upper pole-to-lower pole ureteroureterostomies, whereas one patient underwent a complex reconstruction of a long narrowing defect utilizing a Scardino-Prince vertical flap. Four patients underwent conventional laparoscopy, while the da Vinci Surgical System was used during the surgical procedures of the other two patients.
The mean operative time was 3.1 hours (range 2.6-4.9 hours) for the entire procedure, including cystoscopic evaluation. Stents were removed 6 weeks postoperatively. The patients were evaluated with retroperitoneal ultrasonography and either intravenous urography or diuretic radionuclide imaging to assess the anatomic integrity of the reconstruction. The presenting symptomatology resolved in all patients.
We believe that complex laparoscopic upper-tract reconstruction in children who benefit from a parenchyma-preserving approach is possible and should be evaluated against open techniques.
我们认为，当考虑采用手术矫正来治疗具有功能良好部分的重复集合系统时，即使在需要复杂重建的情况下，肾水平的腹腔镜手术方法也是可行的。
6例年龄在4个月至10岁（平均年龄5.2岁）的儿童，因尿路感染、尿失禁或疼痛就诊，并接受了经腹膜腹腔镜手术，以修复具有保留功能的肾部分的重复集合系统病变。5例患者接受了腹腔镜上极至下极输尿管输尿管吻合术，而1例患者利用Scardino-Prince垂直皮瓣对长狭窄缺损进行了复杂重建。4例患者接受了传统腹腔镜手术，另外2例患者在手术过程中使用了达芬奇手术系统。
整个手术（包括膀胱镜评估）的平均手术时间为3.1小时（范围2.6 - 4.9小时）。术后6周取出支架。通过腹膜后超声以及静脉肾盂造影或利尿放射性核素成像对患者进行评估，以评估重建的解剖完整性。所有患者的现有症状均得到缓解。
我们认为，对于受益于保留实质方法的儿童，进行复杂的腹腔镜上尿路重建是可行的，并且应该与开放手术技术进行对比评估。
