Harper Jonathan D, Shah Satyan K, Baldwin D Duane, Moorhead J David
Division of Urology, Loma Linda University Medical Center, Loma Linda, California 92354, USA.
Urology. 2007 Jul;70(1):153-6. doi: 10.1016/j.urology.2007.01.098.
To describe our experience with pediatric laparoscopic nephrectomy (LN) and laparoscopic nephroureterectomy (LNU) for giant hydronephrosis.
A retrospective review was conducted of all pediatric patients undergoing a transperitoneal LN or LNU. Five of these patients had giant hydronephrosis in a nonfunctioning kidney. Because of chronic infection and the massive nature of hydronephrosis, the system was internally decompressed with an end-hole stent. Partial decompression provided space in the abdomen for adequate visualization while maintaining enough turgidity to facilitate dissection.
Three LNs and two LNUs were performed in children with giant hydronephrosis. All cases were completed laparoscopically. Vascular anatomy and/or orientation were anomalous in all cases because of mass effect. Mean patient age was 9 years (range, 3 to 17 years). Average surgery time was 281 minutes (range, 225 to 410 minutes), and mean estimated blood loss was 27 mL (range, 5 to 50 mL). Mean time to oral intake was 6.5 hours (range, 4 to 11 hours). All patients were discharged on postoperative day 3, and there were no major or minor complications.
Although pediatric LN and LNU for giant hydronephrosis present unique challenges owing to the large renal volume in a small abdominal cavity, these procedures can be safely performed with careful attention to the altered anatomic relationships.
描述我们在小儿腹腔镜肾切除术（LN）和腹腔镜肾输尿管切除术（LNU）治疗巨大肾积水方面的经验。
对所有接受经腹LN或LNU的小儿患者进行回顾性研究。其中5例患者患有无功能肾的巨大肾积水。由于慢性感染和肾积水的巨大体积，采用端孔支架对肾盂系统进行内引流减压。部分减压可在腹腔内提供足够的空间以利于充分显露，同时保持足够的张力以方便进行解剖操作。
对患有巨大肾积水的儿童进行了3例LN和2例LNU手术。所有病例均通过腹腔镜完成。由于肿块效应，所有病例的血管解剖结构和/或走行均异常。患者平均年龄为9岁（范围3至17岁）。平均手术时间为281分钟（范围225至410分钟），平均估计失血量为27毫升（范围5至50毫升）。平均恢复经口进食时间为6.5小时（范围4至11小时）。所有患者均在术后第3天出院，无任何大小并发症。
尽管由于小儿腹腔较小而肾脏体积巨大，小儿LN和LNU治疗巨大肾积水存在独特挑战，但通过仔细关注改变的解剖关系，这些手术可以安全地进行。
