Department of Urology, Cukurova University, Adana, Turkey.
J Endourol. 2010 Nov;24(11):1795-9. doi: 10.1089/end.2010.0338. Epub 2010 Sep 29.
In children with end-stage reflux nephropathy, nephroureterectomy can be performed either open or laparoscopically. It is not common to use a three-trocar retroperitoneal approach for nephroureterectomy with complete ureteral excision in the pediatric age group. We report the results of pediatric retroperitoneoscopic nephroureterectomies by using three trocars only.
Between August 2003 and November 2009, 13 children-seven boys and six girls-with end-stage reflux nephropathy underwent retroperitoneoscopic nephroureterectomy. The operations were performed by using three trocars with the patient in a flank position under general anesthesia. Renal blood vessels were individually dissected and divided followed by the transection of the ureter at the level of the ureterovesical junction.
The mean age of the patients was 6.5 ± 4.4 years (15 months-14 years). Eight of the operations were performed on the left and five on the right side. Mean operative time was 137 ± 47 minutes (75-230 min). Estimated blood losses were minimal. Mean hospitalization time was 2.2 ± 0.9 days (2-5 d). No major intraoperative complication was seen. Overall postoperative analgesic requirement was minimal. Cosmetic results were excellent at the initial postoperative visit.
Retroperitoneoscopic nephroureterectomy by using three trocars is feasible and safe with excellent outcomes in pediatric patients with end-stage reflux nephropathy.
在患有终末期反流性肾病的儿童中，可以采用开放性或腹腔镜手术进行肾输尿管切除术。在儿科年龄段，采用三套管经腹膜后入路行完全输尿管切除的肾输尿管切除术并不常见。我们报告仅使用三个套管进行小儿后腹腔镜肾输尿管切除术的结果。
在 2003 年 8 月至 2009 年 11 月期间，13 例患有终末期反流性肾病的儿童（7 名男孩和 6 名女孩）接受了后腹腔镜肾输尿管切除术。手术在全身麻醉下，患者处于侧卧位，使用三个套管进行。单独解剖和分离肾血管，然后在输尿管膀胱连接部水平处切断输尿管。
患者的平均年龄为 6.5 ± 4.4 岁（15 个月至 14 岁）。8 例手术在左侧进行，5 例在右侧进行。平均手术时间为 137 ± 47 分钟（75-230 分钟）。估计失血量很少。平均住院时间为 2.2 ± 0.9 天（2-5 天）。术中未见重大并发症。总体术后镇痛需求最少。术后初诊时美容效果极佳。
对于患有终末期反流性肾病的小儿患者，使用三个套管进行后腹腔镜肾输尿管切除术是可行且安全的，具有良好的效果。
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