Muller Cécile O, Blanc Thomas, Peycelon Matthieu, El Ghoneimi Alaa
Department of Pediatric Surgery and Urology, Hôpital Robert Debré, APHP, Paris, France.
Department of Pediatric Surgery and Urology, Hôpital Necker, APHP, Paris, France.
J Pediatr Urol. 2015 Dec;11(6):353.e1-5. doi: 10.1016/j.jpurol.2015.04.042. Epub 2015 Jul 17.
Ectopic kidney is a rare urologic condition and may be revealed by ureteropelvic junction obstruction (UPJO) in children, with pelvic kidney being the most common location. Our experience using a minimally invasive approach to treat UPJO by dismembered pyeloplasty led us to report five cases of UPJO with pelvic kidney operated on by transperitoneal laparoscopy, focusing on medium-term follow-up results and surgical technique.
From 1999 to 2010, we reviewed all cases of UPJO managed in our center, a total of 391 patients. Among those, 125 patients were operated on via a minimal invasive approach, 104 by retroperitoneoscopy, and 21 by transperitoneal laparoscopy. Five patients presented ectopic pelvic kidney and were retrospectively reviewed. US-scan and uro-MRI were done preoperatively in all cases for anatomic and functional evaluation. Peri-operative data such as operative time, transfusion, and complications were reported. At last clinic, sonographic and functional evaluation was noted. Focusing on surgical technique, we reported the tips and tricks to successfully and easily perform the dismembered pyeloplasty: optimization of the trocars' location according to the kidney location and use of a transparietal stay stitch to stabilize the suture line of the pyeloplasty.
All five patients underwent dismembered pyeloplasty, at a mean age of 8 years and a mean weight of 23.4 kg. Mean operative time was 213 min (min-max: 180-245). One case of giant hydronephrosis and megacalicosis required conversion at the beginning of the learning curve. None of the patients required blood transfusion. Mean hospital stay was 2.4 days (range: 1-4). All the patients had an uneventful postoperative recovery and good postoperative functional results, with either stable or improved pelvic dilatation and renal function at a mean follow-up of 3.3 years (range: 2-5.6).
This small series of five ectopic kidneys reflects the surgical challenge for the pediatric surgeon to perform reconstructive surgery on an abnormal anatomy. However, increasing experience in robotics in urologic pediatric surgery may lead to shortening of operative time and facilitate both dissection and suturing.
Dismembered pyeloplasty by transperitoneal laparoscopy is a feasible although technically demanding, safe and effective approach in the management of ureteropelvic junction obstruction in pelvic kidney in children.
异位肾是一种罕见的泌尿系统疾病，在儿童中可能因输尿管肾盂连接部梗阻（UPJO）而被发现，其中盆腔肾是最常见的位置。我们采用微创方法通过离断性肾盂成形术治疗UPJO的经验促使我们报告5例经腹膜腹腔镜手术治疗的盆腔肾UPJO病例，重点关注中期随访结果和手术技术。
1999年至2010年，我们回顾了本中心所有UPJO病例，共391例患者。其中，125例患者通过微创方法手术，104例经后腹腔镜手术，21例经腹膜腹腔镜手术。5例患者为异位盆腔肾，进行了回顾性分析。所有病例术前均行超声扫描和泌尿系统MRI检查以进行解剖和功能评估。报告手术时间、输血情况和并发症等围手术期数据。在最后一次门诊时，记录超声和功能评估结果。重点关注手术技术，我们报告了成功且轻松进行离断性肾盂成形术的技巧和窍门：根据肾脏位置优化套管针位置，并使用经壁牵引缝线稳定肾盂成形术的缝合线。
所有5例患者均接受了离断性肾盂成形术，平均年龄8岁，平均体重23.4千克。平均手术时间为213分钟（最小值 - 最大值：180 - 245）。在学习曲线初期，1例巨大肾积水和巨输尿管症患者需要中转手术。所有患者均无需输血。平均住院时间为2.4天（范围：1 - 4天）。所有患者术后恢复顺利，术后功能结果良好，平均随访3.3年（范围：2 - 5.6年）时盆腔扩张和肾功能稳定或改善。
这一小系列的5例异位肾反映了小儿外科医生对异常解剖结构进行重建手术的挑战。然而，小儿泌尿外科手术中机器人技术经验的增加可能会缩短手术时间，并便于解剖和缝合。
经腹膜腹腔镜离断性肾盂成形术是治疗儿童盆腔肾输尿管肾盂连接部梗阻的一种可行方法，尽管技术要求较高，但安全有效。
