MacDonald Caroline, Small Robert, Flett Martyn, Cascio Salvatore, O'Toole Stuart
The Royal Hospital for Children, Glasgow, Scotland.
The Royal Hospital for Children, Glasgow, Scotland. Electronic address: Stuart.O'
J Pediatr Surg. 2019 Feb;54(2):331-334. doi: 10.1016/j.jpedsurg.2018.10.097. Epub 2018 Nov 7.
Recent reports in the literature suggest an increased risk of complications with retroperitoneal as opposed to transperitoneal approach to partial nephrectomy (PN) and total nephrectomy (TN). We are a large unit performing predominantly retroperitoneoscopic PN and TN. We aim to review our outcomes and perform analysis to elucidate the predictors of complications following the retroperitoneal approach for extirpative kidney surgery.
We performed a single center retrospective review of children undergoing MIMS TN and PN between 2005 and 2015. Variables were tested for association with outcomes using Chi and Spearman's Rho correlation.
We performed 173 MIMS nephrectomies, 119 total and 54 partial. Median age and weight were 5 years (6 months to 18 years) and 24.9 kg (7.7 to 85 kg) and operative time 147 min. There were 4 conversions and 17 postoperative complications. 19.6% children required further surgery, including 8 completion stumpectomies. Retroperitoneal approach did not have increased risk compared to transperitoneal for need of further surgery. Partial nephrectomy was not associated with higher rate of intraoperative complication or LOS. Predictors of intraoperative complication were vessel closure technique. Associations with need for further surgery were: ESRF, contralateral disease, bladder dysfunction, presence of PD catheter, and need for concomitant procedure.
Our conversion rate (1.9%) and need for further surgery (13.1%) following the retroperitoneal approach to the kidney are favorable to the literature. Need for reoperation is often associated with the underlying diagnosis and the natural sequelae of the disease process.
IV.
文献中的近期报道表明，与经腹腔途径相比，后腹腔途径进行部分肾切除术（PN）和全肾切除术（TN）时并发症风险增加。我们是一个主要进行后腹腔镜PN和TN手术的大型医疗单位。我们旨在回顾我们的手术结果并进行分析，以阐明后腹腔途径进行肾切除手术并发症的预测因素。
我们对2005年至2015年间接受MIMS TN和PN手术的儿童进行了单中心回顾性研究。使用卡方检验和Spearman秩相关检验变量与手术结果之间的关联。
我们共进行了173例MIMS肾切除术，其中119例为全肾切除，54例为部分肾切除。中位年龄和体重分别为5岁（6个月至18岁）和24.9千克（7.7至85千克），手术时间为147分钟。有4例中转手术和17例术后并发症。19.6%的儿童需要进一步手术，其中包括8例完整肾残端切除术。与经腹腔途径相比，后腹腔途径进行进一步手术的风险并未增加。部分肾切除术与术中并发症发生率或住院时间延长无关。术中并发症的预测因素是血管闭合技术。与需要进一步手术相关的因素包括：终末期肾病、对侧疾病、膀胱功能障碍、腹膜透析导管的存在以及是否需要同期手术。
我们采用后腹腔途径进行肾脏手术的中转率（1.9%）和进一步手术的需求（13.1%）优于文献报道。再次手术的需求通常与潜在诊断和疾病进程的自然转归相关。
IV级。
