Badawy H, Saad A, Fahmy A, Dawood W, Aboulfotouh A, Kamal A, Refaei K, Zoaier A, Youssef M
Department of Urology, University of Alexandria, Egypt.
Department of Urology, University of Alexandria, Egypt.
J Pediatr Urol. 2017 Oct;13(5):511.e1-511.e4. doi: 10.1016/j.jpurol.2017.03.025. Epub 2017 Apr 17.
Laparoscopic pyeloplasty in children has stood the test of time. A clear advantage of laparoscopic pyeloplasty over open pyeloplasty has been proven both by retrospective and prospective trials. The aim of the current study was to address, in a prospective design, the outcomes, safety, conversion rates and risk factors for conversion in children aged <2 years who underwent retroperitonoscopic pyeloplasty by a single surgeon.
In the period April 2014 to May 2016, 15 children with a median age of 6 months (range 1-24) and ureteropelvic junction (UPJ) obstruction were operated by a single surgeon using retroperitonoscopic pyeloplasty with antegrade renal stenting. The position and sites of tracers are shown in the figure.
With a median follow-up of 6 months, there were no recurrent cases of UPJO; one child had postoperative complications and recovered conservatively; median hospital stay was 1 day (range 1-7); and conversion to open pyeloplasty was encountered in three children (20%) aged <3 months. A statistically significant difference between laparoscopic and converted cases was present concerning the age (P = 0.048); neither gender nor side was significantly different.
Laparoscopic pyeloplasty in young children has been reported in many retrospective trials. Retroperitonoscopic pyeloplasty in young children has not been reported in prospectively designed studies to address safety and outcome. The current study reported experience in young children, defining the age category <3 months as a high-risk group for conversion to open surgery, but not to higher incidence of complications.
Retroperitonoscopic pyeloplasty in children aged <2 years is feasible, safe and successful. High conversion rates to open pyeloplasty have to be expected in children aged <3 months.
儿童腹腔镜肾盂成形术已经经受住了时间的考验。回顾性和前瞻性试验均已证实，腹腔镜肾盂成形术相对于开放肾盂成形术具有明显优势。本研究的目的是以前瞻性设计探讨年龄小于2岁的儿童接受由单一外科医生进行的后腹腔镜肾盂成形术的手术效果、安全性、中转率及中转危险因素。
2014年4月至2016年5月期间，15例中位年龄为6个月（范围1 - 24个月）且患有输尿管肾盂连接部（UPJ）梗阻的儿童由单一外科医生采用后腹腔镜肾盂成形术并进行顺行性肾造瘘术。示踪剂的位置和部位见图。
中位随访6个月，无UPJO复发病例；1例儿童有术后并发症，经保守治疗后康复；中位住院时间为1天（范围1 - 7天）；3例年龄小于3个月的儿童（20%）中转至开放肾盂成形术。腹腔镜手术组与中转手术组在年龄方面存在统计学显著差异（P = 0.048）；性别和患侧均无显著差异。
许多回顾性试验报道了幼儿腹腔镜肾盂成形术。前瞻性设计研究中尚未报道幼儿后腹腔镜肾盂成形术的安全性和手术效果。本研究报告了幼儿手术经验，将年龄小于3个月的儿童定义为中转至开放手术的高危组，但并发症发生率并未更高。
年龄小于2岁的儿童后腹腔镜肾盂成形术是可行、安全且成功的。年龄小于3个月的儿童预期有较高的中转至开放肾盂成形术的比例。
