Bajpai Minu, Khanna Kashish, Khanna Vikram, Goel Prabudh, Baidya Dalim Kumar
Department of Pediatric Surgery, All India Institute of Medical Sciences, New Delhi, India.
Department of Anaesthesia, All India Institute of Medical Sciences, New Delhi, India.
J Indian Assoc Pediatr Surg. 2020 May-Jun;25(3):163-168. doi: 10.4103/jiaps.JIAPS_5_19. Epub 2020 Apr 11.
Pelvi-ureteric junction obstruction (PUJO) is one of the most common conditions presenting to a pediatric urologist. As laparoscopic or robotic-assisted pyeloplasty, either transperitoneal or retroperitoneal, involves intracorporeal suturing skills and has a long learning curve, they have not gained popularity among beginners in laparoscopy.
We conducted a study to assess the results of a single-port, retroperitoneoscopic approach to renal access, i.e. lumboscopic-assisted pyeloplasty (LAP), by single surgeon at our institute.
A retrospective review of all children who underwent LAP from July 2013 to March 2018 was conducted. Patients who presented with PUJO and required surgical treatment were included. A single-port lumboscopy using coaxial telescope was performed in prone position in all patients. The renal pelvis was dissected and retrieved through the port site followed by extracorporeal hand-sewn pyeloplasty over a double-J stent or a nephrostent. The operative time, postoperative pain, surgical complications, duration of hospital stay, follow-up, and cosmesis at 6 months postsurgery were evaluated.
A total of 96 children were included (72 males and 24 females), with the age at operation ranging from 3 months to 10 years (mean = 4.9 years). All patients had an uneventful postoperative recovery. Two patients had a superficial wound infection, and one patient was converted to open approach due to excessive bleeding. The average operating time was 80 ± 22.5 min, the median duration of hospital stay was 3 days, and the average scar length at 3 months was 15.6 ± 0.4 mm. Follow-up renogram (diethylenetriamine pentaacetic acid) showed satisfactory postpyeloplasty drainage pattern in 93 children while three showed obstructive drainage curves.
LAP can be performed safely with minimal retroperitoneal dissection, excellent cosmetic results, and minimal postoperative pain in children with PUJO. It has a shorter learning curve as compared to laparoscopic pyeloplasty as it involves time tested extracorporeal hand-sewn anastomosis.
肾盂输尿管连接部梗阻（PUJO）是小儿泌尿外科医生最常遇到的病症之一。由于腹腔镜或机器人辅助肾盂成形术，无论是经腹腔还是经腹膜后，都需要体内缝合技术且学习曲线较长，因此在腹腔镜手术初学者中并不受欢迎。
我们进行了一项研究，以评估我院一名外科医生采用单孔经腹膜后腹腔镜入路行肾脏手术，即腰腹腔镜辅助肾盂成形术（LAP）的效果。
对2013年7月至2018年3月期间所有接受LAP手术的儿童进行回顾性研究。纳入患有PUJO且需要手术治疗的患者。所有患者均在俯卧位采用同轴望远镜进行单孔腰腹腔镜检查。解剖肾盂并通过切口取出，然后在双J支架或肾造瘘支架上进行体外手工缝合肾盂成形术。评估手术时间、术后疼痛、手术并发症、住院时间、随访情况以及术后6个月的美容效果。
共纳入96例儿童（男72例，女24例），手术年龄为3个月至10岁（平均4.9岁）。所有患者术后恢复顺利。2例患者出现浅表伤口感染，1例患者因出血过多转为开放手术。平均手术时间为80±22.5分钟，中位住院时间为3天，3个月时平均瘢痕长度为15.6±0.4毫米。随访肾图（二乙三胺五乙酸）显示，93例儿童肾盂成形术后引流模式满意，3例显示梗阻性引流曲线。
对于患有PUJO的儿童，LAP手术可以在最小限度的腹膜后解剖下安全进行，具有极佳的美容效果和最小的术后疼痛。与腹腔镜肾盂成形术相比，它的学习曲线更短，因为它采用了经过时间检验的体外手工缝合吻合术。
