Laparoscopic distal ureteral end-to-side anastomosis for the treatment of duplication of kidney and ureter in children
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摘要: 目的 分析腹腔镜输尿管远端端侧吻合术治疗小儿重复肾输尿管畸形的疗效。方法 回顾性分析2020年10月—2022年5月河北省儿童医院泌尿外科采用腹腔镜输尿管远端端侧吻合术治疗重复肾输尿管畸形9例患儿，临床表现为滴尿或反复泌尿系统感染。女8例，男1例；年龄1岁6个月~12岁；单侧发病，左侧6例，右侧3例。术前均行泌尿系B超、CT尿路成像(CTU)、排尿性膀胱尿道造影(VCUG)检查，确诊为完全重复肾输尿管畸形，其中重复输尿管开口异位7例，重复肾输尿管末端囊肿2例。术后4~6周拔除输尿管双J管，同时行输尿管镜检查。本组患儿术后随访3~12个月。结果 本组患儿均在腹腔镜下行患侧输尿管远端端侧吻合术，手术时间90~120 min，平均110 min。术后3 d拔除尿管，排尿正常，滴尿现象消失，复查尿常规示白细胞于正常范围。7例术后5 d出院，2例术后7 d出院。术后拔除输尿管双J管行输尿管镜检查见吻合口通畅，呈双腔通路。术后3~12个月复查泌尿系B超示重复输尿管积水扩张均较术前减轻，正常排尿间期无滴尿现象，尿常规未见异常。结论 腹腔镜输尿管远端端侧吻合术治疗小儿重复肾输尿管畸形安全有效，手术简捷，相对于重复肾输尿管切除、输尿管膀胱再植术具有创伤小、并发症少等优势。Abstract: Objective To explore the efficacy of laparoscopic distal ureteral end-to-side anastomosis in children with duplication of kidney and ureter.Methods The clinical data of 9 patients who underwent laparoscopic distal ureteral end-to-side anastomosis from October 2020 to May 2022 were retrospectively analyzed. Clinical symptoms included urinary dripping and recurrent urinary tract infection. There were 8 girls and 1 boy, aged from 1 year and 6 months to twelve years. The duplex kidneys were all located on one side, 6 on the left side, and 3 on the right side. Ultrasonography, computed tomography urography (CTU) and voiding cystourethrogram (VCUG) were performed before surgery. A total of 9 children were diagnosed with complete duplication of renal and ureteral malformation including 7 cases with ectopic ureteral orifice and 2 cases with ureterocele. The D-J tube was removed and ureteroscopy was performed at 4-6 weeks after operation. All patients were followed up for 3 to 12 monthsResults Laparoscopic surgery was performed successfully in all patients. The average operating time was 110 minutes (90-120 minutes). The symptom of urinary dripping disappeared after the catheter was removed three days after operation and reexamination of routine urine showed that white blood cells were normal. Seven patients were discharged 5 days after operation, and 2 patients were discharged 7 days after operation. Ureteroscopy was performed after the removal of the D-J tube, which showed that the anastomosis was patently presented with double lumen access. All patients were followed up from 3 months to 12 months with relieved hydronephrosis. No clinical symptoms were observed in all patients.Conclusion Laparoscopic distal ureteral end-to-side anastomosis is a safe, effective and simple method for the treatment of duplication of kidney and ureter in children. It is superior to the operation of nephroureterectomy and replantation of the ureter and bladder for its less invasion, complications and other advantages.
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