Esposito Ciro, Varlet Francois, Patkowski Dariusz, Castagnetti Marco, Escolino Maria, Draghici Isabela Magdalena, Settimi Alessandro, Savanelli Antonio, Till Holger
Department of Translational Medical Sciences, Federico II University of Naples, Via Pansini 5, 80131, Naples, Italy.
Department of Pediatric Surgery, Centre Hospitalier Universitaire, Hopital Nord, Saint-Étienne, France.
Surg Endosc. 2015 Dec;29(12):3469-76. doi: 10.1007/s00464-015-4096-y. Epub 2015 Feb 12.
We aim to report a 5-year retrospective multicentric European survey about the outcome of laparoscopic partial nephrectomy in infants and children with duplex kidneys.
The data of fifty-two children underwent laparoscopic partial nephrectomy (42 upper-pole nephrectomies and 10 lower-pole nephrectomies) in six European centers of Pediatric Surgery, were collected and analyzed. Median age at surgery was 5.1 years (range 6 months-9.7 years). There were 32 girls and 20 boys. In 37 patients, the left side was affected and in 15 patients the right side. For the right side, 4 trocars were used and for the left side 3/4 trocars. Special hemostatic devices were used for dissection and parenchymal section in all centers. We assessed intraoperative and postoperative morbidity.
Median length of surgery was 166.2 min (70-215 min). No conversion to open surgery nor intraoperative bleeding was reported. Mean hospitalization was 3.5 days. We recorded 10/52 complications (4 urinomas, 2 recurrent UTIs, 4 prolonged urinary leakage), all managed conservatively. Reoperation rate was 0%. No loss of renal function on the residual kidney moiety was recorded in all operated patients.
Laparoscopic partial nephrectomy remains a technically challenging procedure performed only in pediatric centers with high experience in minimally invasive surgery. Although the median operative time was higher than 2 h, we recorded no conversions in our series. The complication rate remains high (10/52-19.2%). All were II grade complications according to Clavien-Dindo classification and were treated conservatively without the need of other surgical procedures.
我们旨在报告一项为期5年的回顾性多中心欧洲调查，内容是关于患有重复肾的婴幼儿和儿童行腹腔镜部分肾切除术的结果。
收集并分析了在六个欧洲小儿外科中心接受腹腔镜部分肾切除术的52例儿童的数据（42例上极肾切除术和10例下极肾切除术）。手术时的中位年龄为5.1岁（范围6个月至9.7岁）。有32名女孩和20名男孩。37例患者左侧受累，15例患者右侧受累。右侧手术使用4个套管针，左侧手术使用3/4个套管针。所有中心在解剖和实质切开时均使用了特殊的止血装置。我们评估了术中及术后的发病率。
手术中位时长为166.2分钟（70 - 215分钟）。未报告中转开放手术及术中出血情况。平均住院时间为3.5天。我们记录到10/52例并发症（4例尿囊肿、2例复发性尿路感染、4例持续性尿漏），均经保守治疗。再次手术率为0%。所有接受手术的患者残余肾部分均未出现肾功能丧失。
腹腔镜部分肾切除术仍然是一项技术上具有挑战性的手术，仅在具有高微创外科经验的儿科中心开展。尽管中位手术时间超过2小时，但我们的系列研究中未记录到中转情况。并发症发生率仍然较高（10/52 - 19.2%）。根据Clavien - Dindo分类法，所有并发症均为Ⅱ级，且经保守治疗，无需其他外科手术。
