Zoeller Christoph, Lacher Martin, Ure Benno, Petersen Claus, Kuebler Joachim F
Center of Pediatric Surgery Hannover, Hannover Medical School and Bult Children's Hospital , Hannover, Germany .
J Laparoendosc Adv Surg Tech A. 2014 Mar;24(3):205-9. doi: 10.1089/lap.2013.0338. Epub 2014 Feb 25.
We compared our experience with intra- and extracorporeal stenting in laparoscopic transabdominal pyeloplasty in children and adolescents. As the placement of transanastomotic stents during laparoscopy can be difficult, we developed a technique for laparoscopic transrenal stent placement.
Eighty-six consecutive patients who underwent laparoscopic transabdominal pyeloplasty in our institution from December 2003 to November 2012 were retrospectively analyzed. Initially we antegradely placed the double J catheter (n=48), whereas in later patients transrenal/transcutaneous stents were inserted (n=38), either via a cannula from the flank (n=33) or from the inside-out by transrenal puncture using a specially constructed spear (n=5). End points of the analysis were stent-related technical problems and complications and the need for reoperation.
Sixty-two boys and 24 girls with a mean age of 5.6 years (range, 78 days-17.3 years) and mean weight of 22.1 kg (range, 5.5-71 kg) underwent laparoscopic transabdominal pyeloplasty. The most common technical problem in the double J group was inability to place the double J catheter in 9 of the 48 patients. In combination with other complications such as dislocations, urinary tract infections, or catheter occlusions, this led to an overall complication rate of 35% in the group that underwent double J catheter insertion versus 13% in the group with transrenal stenting (P<.05). In the whole series, 4 patients required a redo pyeloplasty, all of them in the double J group.
We recommend transrenal stents to facilitate stent removal without general anesthesia and to minimize complications such as stent dislocation. The initial experience with our simple device for transrenal puncture and stent placement is promising.
我们比较了在儿童和青少年腹腔镜经腹肾盂成形术中进行体内和体外支架置入的经验。由于在腹腔镜检查期间放置经吻合口支架可能困难，我们开发了一种腹腔镜经肾支架置入技术。
回顾性分析了2003年12月至2012年11月在我们机构接受腹腔镜经腹肾盂成形术的86例连续患者。最初我们顺行放置双J导管（n = 48），而在后来的患者中插入经肾/经皮支架（n = 38），要么通过来自侧腹的套管（n = 33），要么使用特制的穿刺针经肾穿刺由内向外插入（n = 5）。分析的终点是与支架相关的技术问题、并发症以及再次手术的必要性。
62名男孩和24名女孩接受了腹腔镜经腹肾盂成形术，平均年龄5.6岁（范围78天至17.3岁），平均体重22.1 kg（范围5.5至71 kg）。双J组最常见的技术问题是48例患者中有9例无法放置双J导管。与其他并发症如移位、尿路感染或导管阻塞相结合，这导致双J导管插入组的总体并发症发生率为35%，而经肾支架置入组为13%（P<0.05）。在整个系列中，4例患者需要再次进行肾盂成形术，全部在双J组。
我们推荐经肾支架以利于在无需全身麻醉的情况下取出支架，并将诸如支架移位等并发症降至最低。我们用于经肾穿刺和支架置入的简单装置的初步经验很有前景。
