Pediatric Surgery Department, Centre de la Mère et de l'Enfant Le Parc, 46 rue du Stauffen, Colmar 68024, France.
J Pediatr Urol. 2010 Apr;6(2):166-70. doi: 10.1016/j.jpurol.2009.06.012. Epub 2009 Aug 3.
To report our experience with laparoscopic transperitoneal (TP) heminephrectomy for duplicated pyeloureteral systems in children under 2 years old.
We retrospectively reviewed the intraoperative evolution and patient outcome of 10 laparoscopic partial ureteronephrectomies (7 upper and 3 lower pole nephrectomies) using a TP approach, performed over 4 years. Mean age at surgery was 9.1 months (range 3.5-20.4), with seven children younger than 1 year. Average follow up based on clinical examinations and renal ultrasounds was 13.9 months (range 1.2-38.5).
The average operative time was 123 min (range 90-195). There was no need for conversion and no intraoperative complications. Mean postoperative hospital stay was 2.9 days. A perirenal collection with spontaneous regression occurred in one case. The main postoperative complication consisted of a diminution in renal function with pyelic dilation in a 4-month-old child, due to inadequate positioning of the remaining moiety. This child remains asymptomatic 3 years after surgery.
We recommend a TP approach for laparoscopic heminephrectomy due to the improved vascular exposure and control, diminished need for renal mobilization, and greater working space that can be obtained, especially in toddlers with a higher morbidity rate caused by the lack of retroperitoneal space.
报告我们在 2 岁以下儿童中使用腹腔镜经腹腔途径（TP）行重复肾盂输尿管系统半肾切除术的经验。
我们回顾性分析了 4 年来在腹腔镜下采用 TP 途径完成的 10 例半输尿管切除术（7 例上极和 3 例下极切除术）的术中演变和患者结果。手术时的平均年龄为 9.1 个月（范围 3.5-20.4），其中 7 例小于 1 岁。基于临床检查和肾脏超声的平均随访时间为 13.9 个月（范围 1.2-38.5）。
平均手术时间为 123 分钟（范围 90-195）。无需转换，无术中并发症。平均术后住院时间为 2.9 天。一例发生肾周积液，自行消退。主要的术后并发症是由于剩余部分的定位不当，导致 4 个月大的儿童肾功能下降和肾盂扩张。该患儿术后 3 年仍无症状。
我们建议采用 TP 途径进行腹腔镜半肾切除术，因为该途径可以更好地暴露和控制血管，减少对肾脏的移动需求，并提供更大的工作空间，尤其是对于由于缺乏腹膜后空间而导致发病率较高的幼儿。
