Hospital Exequiel González Cortés and Clínica Alemana, Santiago, Chile.
Pediatric Urology Service, Hospital Dr. Exequiel González Cortés and Clínica Alemana, Universidad de Chile, Av Gran Avenida 3300, San Miguel, Santiago, Chile.
World J Urol. 2023 Jun;41(6):1675-1679. doi: 10.1007/s00345-023-04359-2. Epub 2023 Mar 22.
Anderson-Hynes pyeloplasty is the technique of choice for the treatment of pyeloureteral junction obstruction (PUJO) with an excellent success rate. Minimally invasive surgery has become the standard of care for the management of PUJO in children. Although it has been comparable to the open approach at all levels, its diffusion or employment in younger children has not been widely adopted. Our aim is to evaluate laparoscopic pyeloplasty outcomes from international academic centers in children under 1 year of age, focusing on feasibility and outcomes including possible complications.
This is review of consecutive infants under 1 year of age who underwent laparoscopic pyeloplasty between 2009 and 2018 with more than 12 months of follow-up. Seven different training centers with different backgrounds participated in this study. Evaluation was carried out with ultrasound and renogram before and after surgery. Demographic data, perioperative characteristics, complications, and results are described and analyzed.
Over 9 years, 124 transperitoneal laparoscopic Anderson-Hynes pyeloplasties were performed on 123 children under 1 year of age; 88 males and 35 females, with 1 case of bilateral PUJO. Of the 124 renal units, 86 were left-sided. Mean age at surgery was 6.6 months (1 week-12 months), with 56% (n = 70) done before 6 months of age. Mean weight at surgery was 6.8 kg (3-12 kg), with 59% (n = 73) weighing less than 8 kg. Mean operative time (skin-to-skin) was 150 min (75-330 min). After a mean follow-up of 46 months (12-84 months), 12 (9%) patients developed complications, with only 1 needing a redo pyeloplasty also done laparoscopically. One child, with deterioration in renal function, underwent nephrectomy.
Laparoscopic pyeloplasty under 1 year of age and/or less than 12 kilos is feasible with lower complication rate. Furthermore, age younger than 6 months and weight less than 8 kg are no longer limiting factors for a successful pyeloplasty as shown by this multicentre study.
Anderson-Hynes 肾盂成形术是治疗肾盂输尿管连接部梗阻 (PUJO) 的首选技术，成功率极高。微创外科已成为儿童 PUJO 治疗的标准。尽管在各个层面上都可与开放手术相媲美，但在年龄较小的儿童中，其普及或应用尚未得到广泛采用。我们的目的是评估国际学术中心在 1 岁以下儿童中进行腹腔镜肾盂成形术的结果，重点是可行性和结果，包括可能的并发症。
这是一项回顾性研究，纳入了 2009 年至 2018 年间接受腹腔镜肾盂成形术且随访时间超过 12 个月的 124 名 1 岁以下婴儿。来自 7 个不同背景的培训中心参与了这项研究。手术前后通过超声和肾图进行评估。描述和分析了人口统计学数据、围手术期特征、并发症和结果。
9 年间，对 123 名 1 岁以下儿童共 124 侧经腹腔腹腔镜 Anderson-Hynes 肾盂成形术；男 88 例，女 35 例，双侧 PUJO1 例。124 个肾脏中，左侧 86 个。手术时的平均年龄为 6.6 个月（1 周-12 个月），56%（n=70）在 6 个月以下接受手术。手术时的平均体重为 6.8kg（3-12kg），59%（n=73）体重小于 8kg。平均手术时间（皮肤到皮肤）为 150 分钟（75-330 分钟）。平均随访 46 个月（12-84 个月）后，12 例（9%）患者发生并发症，仅 1 例需要再次腹腔镜肾盂成形术。1 例患儿肾功能恶化，行肾切除术。
1 岁以下和/或体重小于 12 公斤的儿童行腹腔镜肾盂成形术是可行的，并发症发生率较低。此外，年龄小于 6 个月和体重小于 8 公斤不再是成功肾盂成形术的限制因素，这一点在多中心研究中得到了证实。
