Yu Xiaofang,Liu Wei,Cao Zengcai,et al.Application of hierarchical and multi-point suspension technique during laparoscopic pyeloplasty[J].Journal of Clinical Pediatric Surgery,,21():370-373.[doi:10.3760/cma.j.cn101785-202108015-014]
Application of hierarchical and multi-point suspension technique during laparoscopic pyeloplasty
- Abstract:
- ObjectiveTo explore the clinical value of hierarchical and multi-point suspension technique during laparoscopic pyeloplasty (LP) for children with congenital ureteropelvic junction obstruction (UPJO).MethodsTaking 138 children with UPJO as the resrch object who received LP treatment in Qilu Hospital of Shandeng University from March 2017 to December 2020.The hierarchical and multi-point suspension technique was applied.There were 114 boys and 24 girls with an average age of 34.8(1-168) month.The lesion side was left (n=98) and right (n=40).Postoperative ultrasonic follow-ups were performed for outcome evaluations.ResultsAll operations were successful.Average operative duration was (108.5±27.7)min,intraoperative anastomotic time (40.1±6.2) min,volume of blood loss (5-25) ml and average postoperative hospitalization stay 5.9 days.Four cases of postoperative urinary infection improved after susceptible anti-inflammatory treatment based upon the results of urine culture.One child of lymphatic leakage improved after delayed removal of abdominal drainage tube and symptomatic supports.For two cases of hematuria,symptoms disappeared after removal of double J stent.During a follow-up period of 6 to 12 months,clinical symptoms disappeared and ultrasonic re-examination revealed that hydronephrosis disappeared or decreased,and renal cortex thickened to varying degrees.ConclusionDuring laparoscopic pyeloplasty,application of hierarchical and multi-point suspension technique offers a better operative field and a satisfactory outcome.It can effectively lower the difficulty of suturing and significantly shorten operative duration.And beginners may master it quickly and easily.
References:
[1] Klingler HC,Remzi M,Janetschek G,et al.Comparison of open versus laparoscopic pyeloplasty techniques in treatment of uretero-pelvic junction obstruction[J].Eur Urol,2003,44(3):340-345.DOI:10.1016/s0302-2838(03)00297-5.
[2] 黄一天,杨猛,温晟,等.儿童肾盂输尿管成形术后不同引流方式的比较研究[J].临床小儿外科杂志,2021,20(3):247-252.DOI:10.12260/lcxewkzz.2021.03.009. Huang YT,Yang M,Wen S,et al.Comparison of different drainage methods after ureteroplasty in children[J].J Clin Ped Sur,2021,20(3):247-252.DOI:10.12260/lcxewkzz.2021.03.009.
[3] Silay MS,Spinoit AF,Undre S,et al.Global Minimally Invasive Pyeloplasty Study in Children:Results from the Pediatric Urology Expert Group of the European Association of Urology Young Academic Urologists working party[J].J Pediatr Urol,2016,12(4):229.e1-e7.DOI:10.1016/j.jpurol.2016.04.007.
[4] Liu D,Zhou H,Ma L,et al.Comparison of laparoscopic approaches for dismembered pyeloplasty in children with ureteropelvic junction obstruction:critical analysis of 11-year experiences in a single surgeon[J].Urology,2017,101:50-55.DOI:10.1016/j.urology.2016.10.007.
[5] Chen JC,Zhang QL,Wang YJ,et al.Laparoscopic disconnected pyeloplasty to treat ureteropelvic junction obstruction (UPJO) in children[J].Med Sci Monit,2019,25:9131-9137.DOI:10.12659/MSM.918164.
[6] Esposito C,Masieri L,Castagnetti M,et al.Robot-assisted vs laparoscopic pyeloplasty in children with uretero-pelvic junction obstruction (UPJO):technical considerations and results[J].J Pediatr Urol,2019,15(6):667.e1-e8.DOI:10.1016/j.jpurol.2019.09.018.
[7] Turner RM 2nd,Fox JA,Tomaszewski JJ,et al.Laparoscopic pyeloplasty for ureteropelvic junction obstruction in infants[J].J Urol,2013,189(4):1503-1507.DOI:10.1016/j.juro.2012.10.067.
[8] Ekin RG,Celik O,Ilbey YO.An up-to-date overview of minimally invasive treatment methods in ureteropelvic junction obstruction[J].Cent European J Urol,2015,68(2):245-251.DOI:10.5173/ceju.2015.543.
[9] 温元毅,王勇,马鑫,等.改良吻合技术对后腹腔镜肾盂成形术学习曲线的改进[J].中华腔镜泌尿外科杂志(电子版),2018,12(4):244-247.DOI:10.3877/cma.j.issn.1674-3253.2018.04.008. Wen YY,Wang Y,Ma X,et al.Modified anastomosis for improvement of learning curve during retroperitoneal laparoscopic dismembered pyeloplasty[J].Chinese Journal of Endourology (Electronic Version),2018,12(4):244-247.DOI:10.3877/cma.j.issn.1674-3253.2018.04.008.
[10] Chen JC,Zhang QL,Wang YJ,et al.Laparoscopic disconnected pyeloplasty to treat ureteropelvic junction obstruction (UPJO) in children[J].Med Sci Monit,2019,25:9131-9137.DOI:10.12659/MSM.918164.
[11] Cao H,Zhou H,Liu K,et al.A modified technique of paraumbilical three-port laparoscopic dismembered pyeloplasty for infants and children[J].Pediatr Surg Int,2016,32(11):1037-1045.DOI:10.1007/s00383-016-3958-2.
[12] Gadelmoula M,Abdel-Kader MS,Shalaby M,et al.Laparoscopic versus open pyeloplasty:a multi-institutional prospective study[J].Cent European J Urol,2018,71(3):342-345.DOI:10.5173/ceju.2018.1693.
[13] Shepherd G,Romero R,Grant H.Slip-knot-loop suture for continuous suturing in laparoscopy[J].J Laparoendosc Adv Surg Tech A,2016,26(3):231-234.DOI:10.1089/lap.2015.0451.
[14] 吕逸清,谢华,黄轶晨,等.传统腹腔镜与机器人辅助腹腔镜技术在儿童肾盂成形术中的临床应用对比[J].中华小儿外科杂志,2019,40(1):41-44.DOI:10.3760/cma.j.issn.0253-3006.2019.01.009. Lü YQ,Xie H,Huang YC,et al.Clinical analysis of conventional laparoscopic and robotic-assisted laparoscopic pyeloplasty in children[J].Chin J Pediatr Surg,2019,40(1):41-44.DOI:10.3760/cma.j.issn.0253-3006.2019.01.009.
[15] Li K,Hu C,Huang W,et al.A modification with threading cannula needle-assisted 4-point suspension fixation for retroperitoneal laparoscopic pyeloplasty in children with ureteropelvic junction obstruction:a cohort study in single center[J].Int Urol Nephrol,2019,51(2):193-199.DOI:10.1007/s11255-018-2048-x.
[16] 曹华林,周辉霞,罗小龙,等.非钳夹式吻合口缝合法在腹腔镜离断式肾盂成形术中的应用[J].中华小儿外科杂志,2016,37(2):139-143.DOI:10.3760/cma.j.issn.0253-3006.2016.02.013. Cao HL,Zhou HX,Luo XL,et al.Application of non-clamping laparoscopic pyeloplasty for ureteropelvic junction obstruction[J].Chin J Pediatr Surg,2016,37(2):139-143.DOI:10.3760/cma.j.issn.0253-3006.2016.02.013.
Memo
收稿日期:2021-08-06;改回日期:。
通讯作者:李爱武,Email:liaiwuxie@aliyun.com