El-Ghoneimi A, Valla J S, Steyaert H, Aigrain Y
Department of Pediatric Surgery, Hôpital Lenval, Nice, France.
J Urol. 1998 Sep;160(3 Pt 2):1138-41. doi: 10.1097/00005392-199809020-00047.
Laparoscopic procedures are still not widely performed by pediatric urologists due to operative time and costs as well as the lack of indications and, thus, the lack of sufficient surgeon experience. We report our experience with the retroperitoneal approach using special inexpensive methods for various indications in children.
From 1994 to 1997 we performed 42 retroperitoneal laparoscopic procedures in 41 children with a mean age of 4 years, including 31 nephrectomies, 8 partial nephrectomies, 2 renal cystectomies and 1 pyelolithotomy. A total of 13 patients were younger than 1 year. Followup ranged from 6 months to 3 years.
Mean operative time was 104 minutes (range 35 to 150) for nephrectomy, 153 (range 90 to 210) for upper pole nephroureterectomy, 135 for pyelolithotomy and 60 for renal cystectomy. Average postoperative stay was 2 days. Conversion was required in 2 cases of partial nephrectomy due to unidentified polar vessels, including 1 involving duodenal perforation.
The indications for retroperitoneal laparoscopy are expanding with the experience of the surgical team. The retroperitoneal approach provides a technique comparable to that of conventional renal surgery.
由于手术时间、费用以及缺乏适应证，进而导致外科医生经验不足，小儿泌尿外科医生仍未广泛开展腹腔镜手术。我们报告了我们使用特殊廉价方法经腹膜后途径治疗儿童各种适应证的经验。
1994年至1997年，我们对41例平均年龄4岁的儿童实施了42例腹膜后腹腔镜手术，包括31例肾切除术、8例部分肾切除术、2例肾囊肿切除术和1例肾盂切开取石术。共有13例患者年龄小于1岁。随访时间为6个月至3年。
肾切除术的平均手术时间为104分钟（范围35至150分钟），上极肾输尿管切除术为153分钟（范围90至210分钟），肾盂切开取石术为135分钟，肾囊肿切除术为60分钟。术后平均住院时间为2天。2例部分肾切除术因未识别的肾极血管而需要中转开放手术，其中1例发生十二指肠穿孔。
随着手术团队经验的积累，腹膜后腹腔镜手术的适应证正在不断扩大。腹膜后途径提供了一种与传统肾脏手术相当的技术。
