Li Ning,Zhou Xuefeng,Yuan Jiyan,et al.Robot-assisted laparoscopic pyeloplasty in children:a report of 9 cases[J].Journal of Clinical Pediatric Surgery,2019,18(04):294-298.[doi:10.3969/j.issn.1671-6353.2019.04.009]
达芬奇机器人在儿童肾盂成形术中的应用体会——附9例报告
- Title:
- Robot-assisted laparoscopic pyeloplasty in children:a report of 9 cases
- 关键词:
- 机器人; 肾盂输尿管连接部梗阻; 肾盂; 肾盂积水; 儿童
- 分类号:
- R857.3;R692.2;R692.7
- 摘要:
- 目的 分析采用达芬奇机器人完成肾盂成形术患儿的临床资料，总结治疗经验，为深入开展儿童机器人手术提供参考。方法 2015年8月至2016年2月华中科技大学同济医学院附属同济医院小儿外科采用达芬奇机器人完成9例儿童肾盂成形术。其中男童8例，女童1例。平均年龄7.6岁。回顾性分析患儿的临床资料，随访治疗效果。结果 9例患儿中4例为单纯肾盂输尿管连接部狭窄，2例为肾盂输尿管连接部息肉，1例为迷走血管压迫输尿管起始部，2例为一期肾盂成形术后再狭窄梗阻病例。所有患儿顺利完成手术，无中转开腹病例。平均手术时间为162 min，手术时间最长的1例为再次手术患儿，手术时间为213 min，最短1例手术时间为106 min。术后平均住院时间为8.7 d，术后随访15~27个月，无肾积水复发或伤口感染等并发症出现。结论 机器人操作灵活，缝合精细，学习曲线更短。但与腹腔镜手术相比，机器人手术也具有费用高，Trocar孔径大等缺点。在严格把握适应证的情况下，机器人手术将是治疗小儿泌尿外科疾病的有效方法。
- Abstract:
- Objective To analyze our preliminary data on robotic-assisted procedures in pediatric urology so as to provide rationales for future robotic-assisted procedures in pediatric urology.Methods From August 2015 to February 2016,9 pediatric patients underwent robotic-assisted laparoscopic pyeloplasty.There were 8 boys and 1 girl with a mean age of 7.6 (5.1-13.1) years.Clinical data was retrospectively analyzed.Results All 9 procedures were successfully completed without a conversion into open surgery.The average operative duration was 162 (106-213) min.The causes were ureteropelvic junction stricture (n=4),ureteropelvic junction polyp (n=2),compression of aberrant renal vessel (n=1) and recurrent ureteropelvic junction stricture after initial operation (n=2).The average length of postoperative hospital stay was 8.7 days and the duration of postoperative follow-up period 15-27 months.So far,no complication has been noticed.Conclusion A robot can achieve flexible handling,finer suture and easier learning.However,in comparison with laparoscopy,robotic-assisted surgery also has such disadvantages as a higher cost and larger Trocar.If its indications are strictly controlled,robotic-assisted surgery is an effective solution for pediatric pyeloplasty.
参考文献/References:
1 Gettman MT,Neururer R,Bartsch G,et al.Anderson-Hynes dismembered pyeloplasty performed using the da Vinci robotic system[J].Urology,2002,60(3):509-513.
2 Minnillo BJ,Cruz JA,Sayao RH,et al.Long-term experience and outcomes of robotic assisted laparoscopic pyeloplasty in children and young adults[J].J Urol,2011,185(4):1455-1460.DOI:10.1016/j.juro.2010.11.056.
3 Tasian GE,Casale P.The robotic-assisted laparoscopic pyeloplasty:gateway to advanced reconstruction[J].Urol Clin North Am,2015,42(1):89-97.DOI:10.1016/j.ucl.2014.09.008.
4 Murthy P,Cohn JA,Gundeti MS.Evaluation of robotic-assisted laparoscopic and open pyeloplasty in children:single-surgeon experience[J].Ann R Coll Surg Engl,2015,97(2):109-114.DOI:10.1308/003588414X14055925058797.
5 Salo M,Sjoberg AT,Anderberg M.Pyeloplasty in children:perioperative results and long-term outcomes of robotic-assisted laparoscopic surgery compared to open surgery[J].Pediatr Surg Int,2016,32(6):599-607.DOI:10.1007/s00383-016-3869-2.
6 Van Batavia JP,Casale P.Robotic surgery in pediatric urology[J].Curr Urol Rep,2014,15(5):402.DOI:10.1007/s11934-014-0402-9.
7 Meininger D,Byhahn C,Markus BH,et al.Total endoscopic Nissen fundoplication with the robotic device "da Vinci" in children.Hemodynamics,gas exchange,and anesthetic management[J].Anaesthesist,2001,50(4):271-275.
8 Riachy E,Cost NG,Defoor WR,et al.Pediatric standard and robot-assisted laparoscopic pyeloplasty:a comparative single institution study[J].J Urol,2013,189(1):283-287.DOI:10.1016/j.juro.2012.09.008.
9 Barbosa JA,Kowal A,Onal B,et al.Comparative evaluation of the resolution of hydronephrosis in children who underwent open and robotic-assisted laparoscopic pyeloplasty[J].J Pediatr Urol,2013,9(2):199-205.DOI:10.1016/j.jpurol.2012.02.002.
10 张茜,曹国庆,汤绍涛,等.daVinic机器人腹腔镜治疗小儿先天性胆总管囊肿[J].临床小儿外科杂志,2016,15(2):137-139.DOI:10.3969/j.issn.1671-6353.2016.02.011. Zhang Q,Cao GQ,Tang ST,et al.da Vinci Robotic System for choledochal cysts in children[J].J Clin Ped Sur,2016,15(2):137-139.DOI:10.3969/j.issn.1671-6353.2016.02.011.
11 Gettman MT,Peschel R,Neururer R,et al.A comparison of laparoscopic pyeloplasty performed with the daVinci robotic system versus standard laparoscopic techniques:initial clinical results[J].Eur Urol,2002,42(5):453-457; discussion 457-458.
12 Asensio M,Gander R,Royo GF,et al.Failed pyeloplasty in children:Is robot-assisted laparoscopic reoperative repair feasible[J].J Pediatr Urol,2015,11(2):69.e1-69.e6.DOI:10.1016/j.jpurol.2014.10.009.
13 Ganpule AP,Sripathi V.How small is small enough? Role of robotics in paediatric urology[J].J Minim Access Surg,2015,11(1):45-49.DOI:10.4103/0972-9941.147689.
14 Ballouhey Q,Villemagne T,Cros J,et al.A comparison of robotic surgery in children weighing above and below 15.0 kg:size does not affect surgery success[J].Surg Endosc,2015,29(9):2643-2650.DOI:10.1007/s00464-014-3982-z.
15 Pelizzo G,Nakib G,Goruppi I,et al.Pediatric robotic pyeloplasty in patients weighing less than 10 kg initial experience[J].Surg Laparosc Endosc Percutan Tech,2014,24(1):e29-e31.DOI:10.1097/SLE.0b013e31828e3f18.
16 Kutikov A,Nguyen M,Guzzo T,et al.Robot assisted pyeloplasty in the infant-lessons learned[J].J Urol,2006,176(5):2237-2239; discussion 2239-2240.DOI:10.1016/j.juro.2006.07.059.
17 Bansal D,Cost NG,DeFoor WR Jr,et al.Infant robotic pyeloplasty:comparison with an open cohort[J].J Pediatr Urol,2014,10(2):380-385.DOI:10.1016/j.jpurol.2013.10.016.
18 杨振,黄格元.机器人在小儿外科手术中的应用及争议[J].临床小儿外科杂志,2016,15(4):317-321.DOI:10.3969/j.issn.1671-6353.2016.04.002. Yang Z,Huang GY.Application and controversies of robot in pediatric surgery[J].J Clin Ped Sur,2016,15(4):317-321.DOI:10.3969/j.issn.1671-6353.2016.04.002.
19 Mahida JB,Cooper JN,Herz D,et al.Utilization and costs associated with robotic surgery in children[J].J Surg Res,2015,199(1):169-176.DOI:10.1016/j.jss.2015.04.087.
相似文献/References:
[1]周小渔,肖雅玲,刘朝阳,等.声控机器手在小儿腹腔镜手术中的应用[J].临床小儿外科杂志,2007,6(04):4.
[2]魏春,何大维,高洁,等.儿童UPJO肾盂收缩频率与积水程度相关性的初步研究[J].临床小儿外科杂志,2019,18(04):288.[doi:10.3969/j.issn.1671-6353.2019.04.008]
Wei Chun,He Dawei,Gao Jie,et al.Renal pelvis peristalsis frequency in different degrees of hydronephrosis caused by ureteropelvic junction obstruction in children[J].Journal of Clinical Pediatric Surgery,2019,18(04):288.[doi:10.3969/j.issn.1671-6353.2019.04.008]
[3]黄轶晨,谢华,吕逸清,等.机器人辅助腹腔镜下Lich-Greqoir手术治疗儿童原发性膀胱输尿管反流[J].临床小儿外科杂志,2020,19(02):150.[doi:10.3969/j.issn.1671-6353.2020.02.012]
Huang Yichen,Xie Hua,Lv Yiqing,et al.Preliminary experience of robotic assisted laparoscopic ureteral reimplantation in children with primary vesicoureteral reflux[J].Journal of Clinical Pediatric Surgery,2020,19(04):150.[doi:10.3969/j.issn.1671-6353.2020.02.012]
[4]张君颀,耿红全.肾积水患儿的肾功能评估与结局预判[J].临床小儿外科杂志,2020,19(03):193.[doi:10.3969/j.issn.1671-6353.2020.03.001]
Zhang Junqi,Geng Hongquan.Recent advances in renal function evaluation and outcome prediction of pediatric hydronephrosis[J].Journal of Clinical Pediatric Surgery,2020,19(04):193.[doi:10.3969/j.issn.1671-6353.2020.03.001]
[5]汪添益,张潍平,韩文文,等.血小板源性生长因子受体α阳性细胞在先天性肾盂输尿管连接部梗阻发病中的表达及意义[J].临床小儿外科杂志,2020,19(03):213.[doi:10.3969/j.issn.1671-6353.2020.03.005]
Wang Tianyi,Zhang Weiping,Han Wenwen,et al.Expression and significance of platelet-derived growth factor receptor alpha-positive cells in stenotic tissue of congenital ureteropelvic junction obstruction[J].Journal of Clinical Pediatric Surgery,2020,19(04):213.[doi:10.3969/j.issn.1671-6353.2020.03.005]
[6]彭柳成,赵夭望,李创业,等.肾盂前后径对胎儿肾积水出生后行肾盂成形术的预测价值分析[J].临床小儿外科杂志,2020,19(03):218.[doi:10.3969/j.issn.1671-6353.2020.03.006]
Peng Liucheng,Zhao Yaowang,Li Chuangye,et al.Predictive value of anteroposterior diameter of renal pelvis in postnatal operation of fetal hydronephrosis[J].Journal of Clinical Pediatric Surgery,2020,19(04):218.[doi:10.3969/j.issn.1671-6353.2020.03.006]
[7]张旭辉,罗添华,王计文,等.UPJO手术中双J管置入膀胱失败的危险因素分析[J].临床小儿外科杂志,2020,19(03):224.[doi:10.3969/j.issn.1671-6353.2020.03.007]
Zhang Xuhui,Luo Tianhua,Wang Jiwen,et al.Analysis of risk factors for failure of double J inserting into bladder during operation of ureteropelvic junction obstruction[J].Journal of Clinical Pediatric Surgery,2020,19(04):224.[doi:10.3969/j.issn.1671-6353.2020.03.007]
[8]李帅,汤绍涛,曹国庆,等.da Vinci机器人辅助胸腔镜下小儿肺叶切除术的初步经验[J].临床小儿外科杂志,2020,19(07):619.[doi:10.3969/j.issn.1671-6353.2020.07.011]
Li Shuai,Tang Shaotao,Cao Guoqing,et al.Preliminary experience of thoracoscopic pulmonary lobectomy using da Vinci robotic-system in children[J].Journal of Clinical Pediatric Surgery,2020,19(04):619.[doi:10.3969/j.issn.1671-6353.2020.07.011]
[9]谢钧韬,高文宗,李作青,等.达芬奇机器人辅助手术治疗儿童双侧肾盂输尿管连接部狭窄[J].临床小儿外科杂志,2021,20(03):257.[doi:10.12260/lcxewkzz.2021.03.011]
Xie Juntao,Gao Wenzong,Li Zuoqing,et al.Robotic-assisted bilateral simultaneous dismembered pyeloplasties in children[J].Journal of Clinical Pediatric Surgery,2021,20(04):257.[doi:10.12260/lcxewkzz.2021.03.011]
[10]李怡,宋宏程,何雨竹,等.儿童先天性肾盂输尿管连接部梗阻性肾积水手术后分肾功能变化的短期随访研究[J].临床小儿外科杂志,2021,20(04):312.[doi:10.12260/lcxewkzz.2021.04.003]
Li Yi,Song Hongcheng,He Yuzhu,et al.Short-term changes in renal function after operations for congenital ureteropelvic junction obstruction[J].Journal of Clinical Pediatric Surgery,2021,20(04):312.[doi:10.12260/lcxewkzz.2021.04.003]
备注/Memo
收稿日期:2017-10-16。
基金项目:国家自然科学基金（编号：81601265）
通讯作者:张文,Email:wzhang@vip.sohu.com