Leung Ling, Chan Ivy Hau Yee, Chung Patrick Ho Yu, Lan Lawrence Chuen Leung, Wong Kenneth Kak Yuen, Tam Paul Kwong Hang
Division of Paediatric Surgery, Department of Surgery, The University of Hong Kong , Queen Mary Hospital, Hong Kong .
J Laparoendosc Adv Surg Tech A. 2016 Apr;26(4):318-23. doi: 10.1089/lap.2015.0095. Epub 2016 Jan 22.
There is no consensus for the management of failed laparoscopic pyeloplasty in pediatric surgical patients, and only limited publications are available. We evaluated here the clinical outcomes of re-intervention for failed laparoscopic transperitoneal pyeloplasty in infants and children.
Retrospective review of all children who had undergone laparoscopic transperitoneal dismembered Anderson-Hynes pyeloplasty for ureteropelvic junction obstruction from 2002 to 2013 was performed. Patients' demographics, indications, operative details, and outcomes for primary operation as well as re-intervention were studied.
There were 42 patients with a median age of 20 months (range, 3-192 months) and a median body weight of 12 kg (range, 6-56 kg) who underwent a total of 46 laparoscopic transperitoneal pyeloplasties during the study period. The median operative time and blood loss were 193 minutes (range, 115-480 minutes) and trace amount (range, trace amount to 400 mL), respectively. No conversion was reported. Ten cases (22%) required re-intervention. No statistically significant risk factor for failed pyeloplasty was identified. Indications for re-intervention included deterioration of differential renal function (n = 6), progressive hydronephrosis (n = 1), urinary ascites (n = 2), and urosepsis (n = 1). Median time of re-intervention was 6.5 ± 38 months postpyeloplasty. Re-intervention was categorized into the redo pyeloplasty group (n = 6) and the urinary diversion group (n = 4) (insertion of double-J ureteral stent or endopyelotomy) with success rates of 50% and 25%, respectively. Among the redo pyeloplasty group, 3 patients underwent redo laparoscopic pyeloplasty, and all of them had drainage restored with a median improvement in differential renal function of 11%. The mean follow-up duration was 77 ± 38 months.
Laparoscopic transperitoneal pyeloplasty is safe and feasible in children. Redo pyeloplasty is a more favorable re-intervention compared with urinary diversion in our series. Redo laparoscopic pyeloplasty has been shown to improve differential renal function.
小儿外科患者腹腔镜肾盂成形术失败后的处理尚无共识，仅有有限的相关文献。我们在此评估婴幼儿及儿童腹腔镜经腹肾盂成形术失败后再次干预的临床结果。
回顾性分析2002年至2013年期间所有因肾盂输尿管连接部梗阻接受腹腔镜经腹离断式安德森-海恩斯肾盂成形术的儿童患者。研究患者的人口统计学资料、手术指征、手术细节以及初次手术和再次干预的结果。
共有42例患者，中位年龄20个月（范围3 - 192个月），中位体重12千克（范围6 - 56千克），在研究期间共接受了46次腹腔镜经腹肾盂成形术。中位手术时间和失血量分别为193分钟（范围115 - 480分钟）和微量（范围微量至400毫升）。未报告中转开腹情况。10例（22%）患者需要再次干预。未发现肾盂成形术失败的统计学显著危险因素。再次干预的指征包括患侧肾功能恶化（n = 6）、进行性肾积水（n = 1）、尿腹水（n = 2）和尿脓毒症（n = 1）。再次干预的中位时间为肾盂成形术后6.5 ± 38个月。再次干预分为再次肾盂成形术组（n = 6）和尿流改道组（n = 4）（置入双J输尿管支架或内镜肾盂切开术），成功率分别为50%和25%。在再次肾盂成形术组中，3例患者接受了再次腹腔镜肾盂成形术，所有患者引流均恢复，患侧肾功能中位改善11%。平均随访时间为77 ± 38个月。
腹腔镜经腹肾盂成形术在儿童中安全可行。在我们的系列研究中，再次肾盂成形术是比尿流改道更有利的再次干预方式。再次腹腔镜肾盂成形术已被证明可改善患侧肾功能。
