Esposito Ciro, Escolino Maria, Miyano Go, Caione Paolo, Chiarenza Fabio, Riccipetitoni Giovanna, Yamataka Atsuyuki, Savanelli Antonio, Settimi Alessandro, Varlet Francois, Patkowski Dariusz, Cerulo Mariapina, Castagnetti Marco, Till Holger, Marotta Rosaria, La Manna Angela, Valla Jean-Stephane
Department of Translational Medical Sciences, "Federico II" University of Naples, Via Pansini 5, 80131, Naples, Italy.
Department of Pediatric General and Urogenital Surgery, Juntendo University School of Medicine, Tokyo, Japan.
World J Urol. 2016 Jul;34(7):939-48. doi: 10.1007/s00345-015-1728-8. Epub 2015 Nov 17.
To compare the outcome of laparoscopic and retroperitoneoscopic approach for partial nephrectomy in infants and children with duplex kidneys.
Data of 102 patients underwent partial nephrectomy in a 5-year period using MIS procedures were analyzed. Fifty-two children underwent laparoscopic partial nephrectomy (LPN), and 50 children underwent retroperitoneoscopic partial nephrectomy (RPN). Median age at surgery was 4.2 years. Statistical analysis was performed using χ (2) test and Student's t test.
The overall complications rate was significantly higher after RPN (15/50, 30 %) than after LPN (10/52, 19 %) [χ (2) = 0.05]. In LPN group, complications [4 urinomas, 2 symptomatic refluxing distal ureteral stumps (RDUS) and 4 urinary leakages] were conservatively managed. In RPN group, complications (6 urinomas, 8 RDUS, 1 opening of remaining calyxes) required a re-operation in 2 patients. In both groups no conversion to open surgery was reported. Operative time (LPN:166.2 min vs RPN: 255 min; p < 0.001) and hospitalization (LPN: 3.5 days vs RPN: 4.1 days; p < 0.001) were significantly shorter in LPN group. No postoperative loss of renal function was reported in both groups.
Our results demonstrate that RPN remains a technically demanding procedure with a significantly higher complications and re-operation rate compared to LPN. In addition, length of surgery and hospitalization were significantly shorter after LPN compared to RPN. LPN seems to be a faster, safer and technically easier procedure to perform in children compared to RPN due to a larger operative space and the possibility to perform a complete ureterectomy in refluxing systems.
比较腹腔镜和后腹腔镜途径对婴幼儿重复肾行部分肾切除术的疗效。
分析5年间采用微创外科手术行部分肾切除术的102例患者的数据。52例儿童接受腹腔镜部分肾切除术（LPN），50例儿童接受后腹腔镜部分肾切除术（RPN）。手术时的中位年龄为4.2岁。采用χ²检验和学生t检验进行统计学分析。
RPN术后总体并发症发生率（15/50，30%）显著高于LPN术后（10/52，19%）[χ² = 0.05]。LPN组的并发症（4例尿囊肿、2例有症状的反流性远端输尿管残端（RDUS）和4例尿漏）采用保守治疗。RPN组的并发症（6例尿囊肿、8例RDUS、1例剩余肾盏开放）中有2例患者需要再次手术。两组均未报告中转开放手术。LPN组的手术时间（166.2分钟 vs RPN：255分钟；p < 0.001）和住院时间（3.5天 vs RPN：4.1天；p < 0.001）显著更短。两组均未报告术后肾功能丧失。
我们的结果表明，与LPN相比，RPN仍然是一项技术要求较高的手术，并发症和再次手术率显著更高。此外，与RPN相比，LPN后的手术时间和住院时间显著更短。由于手术空间更大且有可能在反流系统中进行完整的输尿管切除术，与RPN相比，LPN似乎是一种在儿童中实施更快、更安全且技术上更简便的手术。
