Zhong Liang, Zou Xiangyu, Sun Jie
Department of Urology, Shanghai Children's Medical Center, Shanghai Jiao Tong University, School of Medicine, Shanghai, China.
Wideochir Inne Tech Maloinwazyjne. 2021 Mar;16(1):256-263. doi: 10.5114/wiitm.2020.94923. Epub 2020 Jun 15.
The most common indication for retroperitoneoscopy in children is poorly functioning kidney, related to reflux or obstruction. Few pediatric urologists attempt to conduct a mass resection operation under retroperitoneoscopy, especially in infants with oncological diseases.
In this study, we describe our experience in a series of resection operations under retroperitoneoscopy to demonstrate its safety and efficacy in children, especially in the treatment of pediatric urology tumor.
A retrospective review of 18 consecutive retroperitoneoscopic resection operations from December 2017 to July 2019 was made. Then a comparison study between retroperitoneoscopy and transperitoneal laparoscopy for exclusively oncological patients was conducted.
Retroperitoneoscopic surgery was successfully performed on 18 patients, 11 having solid tumors, 2 with cysts, and 5 with nonfunctioning or poorly functioning kidneys. The mean age was 69.5 ±46.9 months. The mean operative time was 138.6 ±57.7 min, while the mean size of the mass was 6.4 ±3.8 cm in the largest diameter. Two patients were converted to open surgery because of large diameter of the mass. The 11 solid tumors which were operated on by retroperitoneoscopic surgery were then compared with 13 consecutive oncological patients undergoing transperitoneal laparoscopy. Retroperitoneoscopy has a lower transfusion rate (p < 0.05) and faster recovery (p < 0.01) compared to transperitoneal laparoscopy.
This study demonstrates that the resection operation of a renal or adrenal specimen under retroperitoneoscopy is feasible and safe in children. It is useful not only to treat patients with benign diseases but also in oncological patients. Retroperitoneoscopy is a recommended surgical approach for children.
儿童后腹腔镜检查最常见的指征是功能不良的肾脏，与反流或梗阻有关。很少有小儿泌尿科医生尝试在后腹腔镜下进行肿块切除术，尤其是患有肿瘤疾病的婴儿。
在本研究中，我们描述了一系列后腹腔镜切除术的经验，以证明其在儿童中的安全性和有效性，特别是在小儿泌尿外科肿瘤的治疗中。
对2017年12月至2019年7月连续18例后腹腔镜切除术进行回顾性研究。然后对仅患有肿瘤疾病的患者进行后腹腔镜检查与经腹腹腔镜检查的对比研究。
18例患者后腹腔镜手术成功，其中11例为实体瘤，2例为囊肿，5例为无功能或功能不良的肾脏。平均年龄为69.5±46.9个月。平均手术时间为138.6±57.7分钟，而肿块最大直径平均为6.4±3.8厘米。2例患者因肿块直径大而转为开放手术。然后将11例接受后腹腔镜手术的实体瘤患者与13例连续接受经腹腹腔镜检查的肿瘤患者进行比较。与经腹腹腔镜检查相比，后腹腔镜检查的输血率更低（p<0.05），恢复更快（p<0.01）。
本研究表明，儿童后腹腔镜下肾标本或肾上腺标本切除术是可行且安全的。它不仅对治疗良性疾病患者有用，对肿瘤患者也有用。后腹腔镜检查是儿童推荐的手术方法。
