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目的:探讨隐藏切口法机器人辅助腹腔镜肾盂输尿管成形术治疗婴幼儿肾盂输尿管连接处梗阻的疗效。方法:回顾性分析我院6例行隐藏切口法机器人辅助腹腔镜肾盂输尿管成形术患儿的临床资料。采用传统腹腔镜方法建立手术操作通道,机器人镜头孔与1号臂操作孔建立在Pfannenstiel皱褶(比基尼线)上,2号臂操作孔建立在肚脐正中,辅助操作孔建立在镜头与2号臂操作孔连线中下1/3处,体内操作基本同普通腹腔镜肾盂输尿管成形术。记录术前、术中、术后相关数据,术后并发症采用Clavien-Dindo分类标准进行分级。结果:6例患儿手术均获得成功,无中转传统腹腔镜和开放手术,无术中并发症。平均手术时间184.5(120~226)min、术中平均出血量9.4(5-15)ml、平均引流管拔除时间4.3(2~9)d、术后平均住院时间6.1(4~10)d。术后并发症ClavienⅠ~Ⅱ级发生率33.3%(经对症处理后均好转),无Ⅲ、Ⅳ级并发症。术后两天与出院当天行超声检查,术侧肾盂前后径明显减小或消失,无梗阻表现。瘢痕掩藏于Pfannenstiel皱褶上,穿上比基尼泳裤体表无可视瘢痕。结论:隐藏切口法机器人辅助腹腔镜肾盂输尿管成形术治疗婴幼儿肾盂输尿管连接处梗阻安全可行,具有视野清晰、操作精准、恢复快、美容效果好等优点。
Objective: To investigate the curative effect of hysterectomy assisted by laparoscopic ureteropelvic pyeloplasty on obstruction of ureteropelvic junction in infants and children. Methods: The clinical data of 6 children underwent laparoscopic ureteropelvic polyposis in our hospital were retrospectively analyzed. The operation lanes were established by traditional laparoscopic method. The robot lens hole and operation arm No. 1 were established on the Pfannenstiel folds (bikini line). The operation arm No. 2 was established in the middle of the navel. The auxiliary operation hole was established between the lens and arm 2 Operation hole connection in the next 1/3, the basic operation with ordinary laparoscopic ureteropelvic angioplasty. Preoperative, intraoperative, postoperative related data and postoperative complications were recorded by Clavien-Dindo classification. Results: All the 6 cases were operated successfully. There were no traditional laparoscopic and open surgery and no intraoperative complications. The mean operative time was 184.5 (ranged from 120 to 226) min. The mean intraoperative blood loss was 9.4 (5-15) ml. The average drainage time was 4.3 (ranged from 2 to 9) days and the average postoperative hospital stay was from 6.1 to 4 days. Postoperative complications Clavien Ⅰ ~ Ⅱ grade incidence of 33.3% (after symptomatic treatment were better), no Ⅲ, Ⅳ grade complications. Two days after surgery and discharged on the line ultrasound, the anteroposterior diameter of the renal side was significantly reduced or disappeared, no obstruction. The scars hide on the Pfannenstiel folds and have no visible scars on the bikini top. Conclusion: Hidden incision robot assisted laparoscopic ureteropelvic pyeloplasty for the treatment of obstructive ureteropelvic junction obstruction safe and feasible, with a clear field of vision, accurate operation, rapid recovery, good cosmetic results.