经Trocar腹腔内顺行插入双J管在儿童腹腔镜下离断式肾盂输尿管成形术中的应用
李福林,马 超,林 阳,张永波

四川省成都市妇女儿童中心医院泌尿外科(四川省成都市,610071)

腹腔镜; 肾盂; 输尿管梗阻; 方法; 儿童

Application of Trocar antegrade insertion of double-J tube during laparoscopic pyeloplasty in children.
Li Fulin, Ma Chao, Lin Yang, Zhang Yongbo.

Department of Urology, Municipal Women & Children's Hospital, Chengdu, Sichuan 610071, China.Corresponding author: Li Fulin, E-mail: lifulin512@163.com

Laparoscopes; Kidney Pelvis; Ureteral Obstruction; Methods; Child

DOI: 10.3969/j.issn.1671-6353.2017.02.014

备注

目的 探讨儿童腹腔镜下离断式肾盂输尿管成形术中放置双J管的方法和技巧。 方法 总结本院2014年12月至2015年12月收治的19例腹腔镜下离断式肾盂输尿管成形术患儿的临床资料,其中男性11例,女性8例。年龄1～10岁,平均年龄4岁。左侧18例,右侧1例,均为肾盂输尿管连接部狭窄伴中重度肾积水。术中均经Trocar于腹腔内顺行放置双J管。 结果 19例均手术成功,其中18例于腹腔镜下顺利放置双J管,1例放置失败,中转开腹完成手术。总手术时间120～150 min,其中放置双J管时间为5～10 min,平均用时8 min。术后腹部X线平片检查双J管一端位于肾盂,另一端位于膀胱内,证实双J管位置正常。术后1～3个月均经膀胱镜顺利拔出双J管,术后3～6个月复查B超,患侧肾盂分离均较术前缩小,肾皮质厚度明显增加,复查肾图分肾功能较术前明显增高。 结论 儿童腹腔镜离断式肾盂输尿管成形术中,经Trocar于腹腔内顺行插入双J管方法安全、简便、快捷、有效。
Objective To explore the techniques of placing a double-J tube during Anderson-Hynes laparoscopic pyeloplasty in children. Methods Analysis was performed for the clinical data of 19 cases of laparoscopic pyeloplasty from December 2014 to December 2015. There were 11 boys and 8 girls with an average age of 4(1～10)years. All of them had ureteropelvic junction obstruction with moderate or severe hydronephrosis. The involved sides were left(n=18)and right(n=1). Results Among 19 cases operated successfully, 18 cases had a double J-tube placed successfully under laparoscopy. And 1 failed case was converted into laparotomy. The total operative duration was 120～150 min and the average time of placing a double-J tube was 8(5～10)min. Radiography showed that one end of double-J tube was located in pelvis while another end in bladder. Double-J tube was definitely placed in a normal position. From 1 to 3 months post-operation, 18 cases were successfully extubated by cystoscopy. At 3～6 months post-operation, ultrasonic examination showed that hydronephrosis shrunk markedly. And there was a significant increase in the thickness of renal cortex. Renal function improved significantly after operation. Conclusion s During Anderson-Hynes laparoscopic pyeloplasty, placing a double-J tube directly through Trocar is safe, simple, convenient, rapid and effective.