Joyeux Luc, Lacreuse Isabelle, Schneider Anne, Moog Raphael, Borgnon Josephine, Lopez Manuel, Varlet François, Becmeur François, Sapin Emmanuel
Academic Department of Development and Regeneration, Cluster Organ Systems, Biomedical Sciences, Faculty of Medicine, Katholieke Universiteit (KU) Leuven, UZ Herestraat 49, Box 1034, 3000, Leuven, Belgium.
Center for Surgical Technologies, Faculty of Medicine, KU Leuven, Leuven, Belgium.
Surg Endosc. 2017 Mar;31(3):1241-1249. doi: 10.1007/s00464-016-5098-0. Epub 2016 Jul 15.
Retroperitoneoscopic upper pole heminephrectomy (RUHN) in duplex kidney in children remains a challenging procedure with a need for postoperative functional assessment of the remnant lower pole. We aimed to calculate the incidence of long-term functional renal outcomes in these children and examine the effect of age on those outcomes.
A multicenter retrospective cohort study of 9 years included all patients undergoing RUHN and evaluated by renal ultrasound (US) and dimercaptosuccinic acid (DMSA) scintigraphy pre and postoperatively. Patients were divided in two age groups of ≤12 and >12 months. Standard follow-up assessed pre-, intra- and postoperative outcomes using clinical review, US and DMSA.
Standard RUHN in lateral position was performed in 30 patients. Five cases were excluded (2 lacks of postoperative DMSA, 3 conversions). Indications for RUHN were non-functioning upper moieties (n = 25) caused by ureterocele (n = 11), ectopic distal implantation of the ureter with incontinence (n = 6) or evolving severe ureterohydronephrosis (n = 8). Mean age at surgery was 30 ± 27 months, operation time 116 ± 52 min and hospital stay 2.8 ± 1 days. Long-term follow-up (mean, 7.2 ± 2.7 years) with US and DMSA showed that none of the 25 patients had complete loss of lower pole renal function. Mean lower pole renal function directly related to RUHN was not significantly different after versus before RUHN for the entire cohort (n = 24; 39.7 ± 7.90 % vs. 41.7 ± 6.74 %; p = 0350), for the ≤12-month (n = 6; 39.3 ± 4.18 vs. 41.3 ± 5.47; p = 0.493) and the >12-month groups (n = 18; 39.8 ± 8.90 vs. 41.9 ± 7.25; p = 0.443). Four patients (17 %) had partial loss of function (mean function loss, 9.3 ± 5.85 %; median age, 13 months). The number and type of complications between the two age groups were not statistically different. Overall, 29 % (n = 7/24) of the patients presented with medium-term (17 %) and long-term (17 %) complications directly related to RUHN.
RUHN is a demanding yet efficient technique that is safe for the lower pole at any age. Systematic postoperative DMSA is not mandatory as long as US remains normal.
儿童重复肾的后腹腔镜上极半肾切除术（RUHN）仍然是一项具有挑战性的手术，术后需要对残余下极进行功能评估。我们旨在计算这些儿童长期肾功能结局的发生率，并研究年龄对这些结局的影响。
一项为期9年的多中心回顾性队列研究纳入了所有接受RUHN手术的患者，并在术前和术后通过肾脏超声（US）和二巯基丁二酸（DMSA）闪烁扫描进行评估。患者被分为两个年龄组，≤12个月和>12个月。标准随访通过临床检查、US和DMSA评估术前、术中和术后结局。
30例患者接受了侧卧位标准RUHN手术。5例被排除（2例缺乏术后DMSA，3例中转）。RUHN的适应证为无功能的上半肾（n = 25），原因包括输尿管囊肿（n = 11）、输尿管远端异位植入伴尿失禁（n = 6）或进展性严重输尿管肾盂积水（n = 8）。手术平均年龄为30±27个月，手术时间116±52分钟，住院时间2.8±1天。US和DMSA的长期随访（平均7.2±2.7年）显示，25例患者中无一例下极肾功能完全丧失。整个队列（n = 24）RUHN术后与术前相比，直接与RUHN相关的平均下极肾功能无显著差异（39.7±7.90%对41.7±6.74%；p = 0.350），≤12个月组（n = 6）（39.3±4.18对41.3±5.47；p = 0.493）和>12个月组（n = 18）（39.8±8.90对41.9±7.25；p = 0.443）。4例患者（17%）出现部分功能丧失（平均功能丧失9.3±5.85%；中位年龄为13个月）。两个年龄组之间并发症的数量和类型无统计学差异。总体而言，29%（n = 7/24）的患者出现了与RUHN直接相关的中期（17%）和长期（17%）并发症。
RUHN是一项要求高但有效的技术，对任何年龄的下极都是安全的。只要US保持正常，系统性术后DMSA并非必需。
