Liu Zhiyuan,Yu Chengjun,Luo Jin,et al.Comparison of efficacy between laparoscopy versus traditional open surgery for pediatric duplex kidney[J].Journal of Clinical Pediatric Surgery,,22():977-981.[doi:10.3760/cma.j.cn101785-202301012-014]
Comparison of efficacy between laparoscopy versus traditional open surgery for pediatric duplex kidney
- Keywords:
- Duplex Kidney; Surgical Procedures; Operative; Treatment Outcome; Child
- Abstract:
- Objective To analysis and compare the efficacy of laparoscopy versus open upper pole heminephrectomy (OUHN) for duplex kidney.Methods A retrospective analysis was performed for 127 children undergoing upper pole heminephrectomy (UHN) from January 2012 to December 2021.They were assigned into two groups of laparoscopy (n=87) and open surgery (n=40).Operative duration,volume of blood loss,hospitalization stay,symptom relief rate,collapse of ureterocele,complication rate,reoperative rate and other parameters were compared between two surgical approaches.Results Operative duration for laparoscopy and open surgery groups was 130.0(100.0,170.0) and 75.0(61.3,85.0) min.Estimated volume of blood loss was (12.5±8.9) mL in laparoscopy group and (23.8±13.9) mL in open surgery group.Postoperative hospitalization stay was (6.3±1.5) days in laparoscopy group and (8.1±1.9) days in open surgery group.The differences in the above parameters were all statistically significant (P<0.001).During an average follow-up period of 14 months,both groups achieved a resolution of hydronephrosis and urinary incontinence.No statistically significant inter-group differences existed in the outcomes of ureterocele,postoperative urinary tract infection rate (4.6% vs.12.5%),incidence of renal parenchymal urine cysts (10.3% vs.20.0%) or cyst diameter (1.8±1.2 vs.2.4±2.6 cm)(P>0.05).Reoperative rate was 2.3%(2/87) in laparoscopy group and 15.0%(6/40) in open surgery group with a statistically significant difference (P=0.019).Reoperative rate for distal ureteral stump syndrome was 1.1%(1/87) in laparoscopy group and 10.0%(4/40) in open surgery group with a statistically significant difference (P=0.034).The incidence of postoperative renal atrophy was 0% in laparoscopy group and 7.5% (3/40) in open surgery group with a statistically significant difference (P=0.030).Conclusion Laparoscopic upper pole heminephrectomy (LUHN) has the same efficacy as OUHN.More mini-invasive with fewer complications,LUHN is an ideal option for duplex kidney in children.
References:
[1] Society for Maternal-Fetal Medicine (SMFM),Hopkins LM.Duplicated collecting system[J].Am J Obstet Gynecol,2021,225(5):B12-B13.DOI:10.1016/j.ajog.2021.06.040.
[2] Jordan GH,Winslow BH.Laparoendoscopic upper pole partial nephrectomy with ureterectomy[J].J Urol,1993,150(3):940-943.DOI:10.1016/s0022-5347(17)35656-2.
[3] You D,Bang JK,Shim M,et al.Analysis of the late outcome of laparoscopic heminephrectomy in children with duplex kidneys[J].BJU Int,2010,106(2):250-254.DOI:10.1111/j.1464-410X.2009.09038.x.
[4] Golebiewski A,Losin M,Murawski M,et al.Laparoscopic versus open upper pole heminephroureterectomy for the treatment of duplex kidneys in children[J].J Laparoendosc Adv Surg Tech A,2013,23(11):942-945.DOI:10.1089/lap.2013.0197.
[5] Piaggio L,Franc-Guimond J,Figueroa TE,et al.Comparison of laparoscopic and open partial nephrectomy for duplication anomalies in children[J].J Urol,2006,175(6):2269-2273.DOI:10.1016/S0022-5347(06)00342-9.
[6] Esposito C,Escolino M,Miyano G,et al.A comparison between laparoscopic and retroperitoneoscopic approach for partial nephrectomy in children with duplex kidney:a multicentric survey[J].World J Urol,2016,34(7):939-948.DOI:10.1007/s00345-015-1728-8.
[7] Houat AP,Guimar?es CTS,Takahashi MS,et al.Congenital anomalies of the upper urinary tract:a comprehensive review[J].Radiographics,2021,41(2):462-486.DOI:10.1148/rg.2021200078.
[8] Society for Maternal-Fetal Medicine,Ghaffari N.Ectopic ureterocele[J].Am J Obstet Gynecol,2021,225(5):B14-B15.DOI:10.1016/j.ajog.2021.06.041.
[9] Dénes FT,Danilovic A,Srougi M.Outcome of laparoscopic upper-pole nephrectomy in children with duplex systems[J].J Endourol,2007,21(2):162-168.DOI:10.1089/end.2006.0228.
[10] 吴双霜,何大维,肖兴望,等.儿童完全性重复肾伴输尿管囊肿的手术方式选择及疗效分析[J].重庆医科大学学报,2019,44(8):1081-1084.DOI:10.13406/j.cnki.cyxb.002041.Wu SS,He DW,Xiao XW,et al.Selection and clinical efficacy of surgical approaches for complete duplex kidney with ureterocele in children[J].J Chongqing Med Univ,2019,44(8):1081-1084.DOI:10.13406/j.cnki.cyxb.002041.
[11] Le HK,Chiang G.Long-term management of ureterocele in duplex collecting systems:reconstruction implications[J].Curr Urol Rep,2018,19(2):14.DOI:10.1007/s11934-018-0758-3.
[12] Plaire JC,Pope JC4th,Kropp BP,et al.Management of ectopic ureters:experience with the upper tract approach[J].J Urol,1997,158(3 Pt 2):1245-1247.
[13] Szklarz MT,Ruiz J,Moldes JM,et al.Laparoscopic upper-pole heminephrectomy for the management of duplex kidney:outcomes of a multicenter cohort[J].Urology,2021,156:245-250.DOI:10.1016/j.urology.2021.01.032.
[14] Polok M,Dzielendziak A,Apoznanski W,et al.Laparoscopic heminephrectomy for duplex kidney in children-the learning curve[J].Front Pediatr,2019,7:117.DOI:10.3389/fped.2019.00117.
[15] Mushtaq I,Haleblian G.Laparoscopic heminephrectomy in infants and children:first 54 cases[J].J Pediatr Urol,2007,3(2):100-103.DOI:10.1016/j.jpurol.2006.05.011.
[16] Wallis MC,Khoury AE,Lorenzo AJ,et al.Outcome analysis of retroperitoneal laparoscopic heminephrectomy in children[J].J Urol,2006,175(6):2272-2282.DOI:10.1016/S0022-5347(06)00338-7.
[17] Luo J,Tan XH,Liu X,et al.Anatomy and management of upper moiety vascular variation in children with duplex kidney[J].J Pediatr Surg,2019,54(10):2130-2133.DOI:10.1016/j.jpedsurg.2019.04.011.
Memo
收稿日期:2023-1-12。
基金项目:重庆市卫健委-科卫联合重点项目 渝卫发[2021]47号2022ZDXM033
通讯作者:魏光辉,Email:u806806@cqmu.edu.cn