多机构微创阑尾置顶输尿管成形术治疗小儿复杂输尿管近端狭窄的远期疗效

IF 2.4 2区医学 Q1 PEDIATRICS

Journal of pediatric surgery Pub Date : 2025-04-08 DOI:10.1016/j.jpedsurg.2025.162316

Hualin Cao , Yangyang Wu , Pin Li , Xiaoyu Yi , Xiaowei Zhang , Hongshuai Jia , Ruyue Jin , Xiangling Deng , Tian Tao , Lifei Ma , Xiaoguang Zhou , Nini An , Yanfang Yang , Jianpeng Bi , Qian Zhang , Ji Li , Yun Zhou , Can Qi , Jiawen Zhao , Bowen Liu , Huixia Zhou

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引用次数: 0

摘要

目的：我们报告腹腔镜和机器人辅助阑尾输尿管成形术（AOU）治疗儿童复杂输尿管近端狭窄（CPU）的长期疗效。方法回顾性分析2010年至2020年间行腹腔镜或机器人AOU治疗CPU的患者。本文描述了患者特征、围手术期手术资料和随访资料。手术入路调整到狭窄的长度和位置，包括腹侧切口或切除病变输尿管，然后用阑尾皮瓣修复。成功是建立在症状缓解和没有阻塞的影像学评估。结果29例患者行微创中央动脉造影（腹腔镜12例，机器人17例）。手术时中位年龄为48个月（IQR, 36.5-69.0）。中位狭窄长度4.0 cm (IQR, 3.3-5.0)，手术时间162.0 min (IQR, 137.0-178.0)，估计失血量25.0 ml （IQR, 20.0-30.0）。无开放性转换及术中并发症发生。14例（48.3%）患者行腹侧膀胱输尿管成形术（包括2例膀胱增强肾盂成形术），15例（51.7%）患者行背侧输尿管重建成形术。总体而言，18例患者出现Ⅰ级或Ⅱ级Clavien-Dindo术后并发症，1例患者出现Ⅲ级并发症。29例患者中有28例（96.6%）手术成功，中位随访6年（IQR, 5.0-7.5）。结论微创AOU是一种安全、可行、有效的治疗儿童CPU狭窄的技术，远期疗效良好。

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Long-term Outcomes of Multi-institutional Minimally Invasive Appendiceal Onlay Ureteroplasty for Managing Complex Proximal Ureteral Strictures in Pediatric Patients

Purpose

We report the long-term outcomes of laparoscopic and robotic-assisted appendiceal onlay ureteroplasty (AOU) for complex proximal ureteral (CPU) strictures in children across multiple institutions.

Methods

Retrospective review of patients who underwent laparoscopic or robotic AOU for CPU between 2010 and 2020. Patient characteristics, perioperative surgical data, and follow-up data are described. The surgical approach was adjusted to the stricture length and location, involving a ventral incision or excision of the diseased ureter followed by repair with an onlay appendiceal flap. Success was established by the presence of symptomatic relief and the absence of obstruction on imaging assessments.

Results

Twenty-nine patients underwent minimally invasive AOU of CPU (12 laparoscopy, 17 robot-assisted). The median age at surgery was 48 months (IQR, 36.5–69.0). The median stricture length measured 4.0 cm (IQR, 3.3–5.0), operative time was 162.0 min (IQR, 137.0–178.0), and estimated blood loss was 25.0 ml (IQR, 20.0–30.0). No open conversions and intraoperative complications occurred. Ventral-side onlay ureteroplasty was performed in 14 (48.3 %) patients (including two onlay augmented pyeloplasty) and Dorsal-side reconstruction ureteroplasty was performed in 15 (51.7 %) patients. Overall, 18 patients had grade Ⅰ or Ⅱ Clavien-Dindo postoperative complications and one patient developed a grade Ⅲ complication. Surgical success was achieved in 28/29 (96.6 %) patients at a median follow-up of 6.0 years (IQR, 5.0–7.5).

Conclusion

Minimally invasive AOU is a safe, feasible, and effective technique for managing CPU strictures in children with good long-term outcomes.

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来源期刊

Journal of pediatric surgery 医学-外科

CiteScore

1.10

自引率

12.50%

发文量

569

审稿时长

38 days

期刊介绍： The journal presents original contributions as well as a complete international abstracts section and other special departments to provide the most current source of information and references in pediatric surgery. The journal is based on the need to improve the surgical care of infants and children, not only through advances in physiology, pathology and surgical techniques, but also by attention to the unique emotional and physical needs of the young patient.