Miyano Go, Takahashi Toshiaki, Nakamura Hiroki, Doi Takashi, Okawada Manabu, Koga Hiroyuki, Lane Geoffrey J, Okazaki Tadaharu, Kato Yoshifumi, Yamataka Atsuyuki
Department of Pediatric General and Urogenital Surgery, Juntendo University School of Medicine, Tokyo, Japan.
J Laparoendosc Adv Surg Tech A. 2013 Aug;23(8):723-7. doi: 10.1089/lap.2013.0135.
Retroperitoneoscopic nephrectomy (R-neph) is still not generally favored by pediatric surgeons for various reasons, including lack of experience of retroperitoneal anatomy compared with pediatric urologists, concern about long operative times, and related complications.
We compared nephrectomies/heminephrectomies planned, performed, and managed by five senior pediatric surgical trainees (SPST) under the supervision of a board-certified pediatric surgeon (BCPS) (A.Y.) using four-trocar retroperitoneoscopy (R-neph) (n=11) with conventional open nephrectomy and heminephrectomy (O-neph) (n=20) performed by 4 BCPS.
O-neph comprised 14 nephrectomies and 6 upper pole nephrectomies; R-neph comprised 9 total nephrectomies and 2 upper pole nephrectomies. Mean age and mean weight at nephrectomy were not statistically different. Mean operating time (MOT) was 137 (range, 85-290) minutes in O-neph versus 197 (116-341) minutes in R-neph. MOT for the first 5 R-neph cases was 249 minutes versus 153 minutes for the last 6 cases. Mean blood loss was 17 (range, 1-55) mL in O-neph versus 10.3 (2-40) mL in R-neph. One R-neph case required conversion to O-neph. There were no transfusions and no intraoperative complications. Two partial heminephrectomy patients (one O-neph and one R-neph) developed transient urinoma postoperatively that resolved conservatively. Mean duration of postoperative bed rest was 1.0 day in O-neph versus 0.6 days in R-neph. Differences in mean postoperative fentanyl requirement (O-neph, 21.5 [10-40] μg/kg; R-neph, 4.1 [0-20] μg/kg) and duration of nonsteroidal anti-inflammatory suppository usage (O-neph, 2.3 [0-5] days; R-neph, 0.9 [0-2] days) were significant (both P<.05). Full oral feeding was resumed after a mean of 1.6 (1-2) days in O neph and 1.2 (1-2) days in R-neph.
R-neph was safely performed by SPST, and results were comparable to those with O-neph performed by BCPS.
由于多种原因，包括与小儿泌尿外科医生相比缺乏腹膜后解剖经验、担心手术时间长及相关并发症，小儿外科医生一般仍不普遍青睐后腹腔镜肾切除术（R肾切除术）。
我们比较了由一名获得委员会认证的小儿外科医生（BCPS）（A.Y.）监督下的五名高级小儿外科实习生（SPST）使用四通道后腹腔镜技术进行的计划、实施和管理的肾切除术/半肾切除术（R肾切除术）（n = 11）与4名BCPS进行的传统开放性肾切除术和半肾切除术（O肾切除术）（n = 20）。
O肾切除术包括14例全肾切除术和6例上极肾切除术；R肾切除术包括9例全肾切除术和2例上极肾切除术。肾切除时的平均年龄和平均体重无统计学差异。O肾切除术的平均手术时间（MOT）为137（范围85 - 290）分钟，而R肾切除术为197（116 - 341）分钟。前5例R肾切除术的MOT为249分钟，而后6例为153分钟。O肾切除术的平均失血量为17（范围1 - 55）mL，而R肾切除术为10.3（2 - 40）mL。1例R肾切除术病例需要转为O肾切除术。无输血情况且无术中并发症。两名部分半肾切除术患者（1例O肾切除术和1例R肾切除术）术后出现短暂尿囊肿，经保守治疗后消退。O肾切除术的术后平均卧床休息时间为1.0天，而R肾切除术为0.6天。术后平均芬太尼需求量（O肾切除术，21.5 [10 - 40] μg/kg；R肾切除术，4.1 [0 - 20] μg/kg）和非甾体类抗炎栓剂使用时间（O肾切除术，2.3 [0 - 5]天；R肾切除术，0.9 [0 - 2]天）的差异具有统计学意义（均P <.05）。O肾切除术平均在1.6（1 - 2）天后恢复全量经口喂养，R肾切除术平均在1.2（1 - 2）天后恢复。
SPST安全地实施了R肾切除术，结果与BCPS实施的O肾切除术相当。
