机器人辅助腹腔镜输尿管造口术治疗一名患儿上尿路倍增

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上尿路倍增仍然是儿科泌尿外科最棘手的问题之一。在治疗患有这种病症的儿童时，已经使用了许多手术方法，但迄今为止，重复手术的发生率仍然很高。本研究旨在展示一例成功的机器人辅助腹腔镜输尿管造口术，讨论该手术的技术问题，并回顾已知的一系列儿童机器人输尿管造口术。本研究对一名右肾倍增并伴有尿液反流至下段集合系统的患儿的病史进行了回顾性分析。手术采用机器人辅助技术进行。利用计算机断层扫描和排尿膀胱尿道造影，确定了右肾上尿路倍增伴膀胱尿液反流至下段的诊断。手术采用了输尿管造口术。供体输尿管在拟吻合区域内交叉。然后对受体输尿管进行输尿管切开术，其长度应与供体输尿管的直径相等。准备好输尿管后，进行端侧吻合。手术顺利进行，没有出现任何技术问题和并发症。手术时间为140分钟，其中机器人安装时间（对接时间）为20分钟，主控台时间为120分钟。患者在术后当天就开始进食。第二天进行对照超声检查后拔除引流管。支架一直留在受体输尿管中，直到术后6周才被取出。随访时间为6个月。患者在整个随访期间均无症状。术后反复进行的超声波检查显示，下段肾盂的前胸直径减小到5毫米。右肾上下段的血流未受干扰。机器人手术方法的优势，包括改善工具的可操作性和三维可视化，使其成为儿童开腹手术或腹腔镜手术的安全有效的替代方案。

作者简介

Yury A. Kozlov

Children’s Regional Clinical Hospital; Irkutsk State Medical Academy of Postgraduate Education; Irkutsk State Medical University

编辑信件的主要联系方式.
Email: yuriherz@hotmail.com
ORCID iD: 0000-0003-2313-897X
SPIN 代码: 3682-0832

MD, Dr. Sci. (Medicine), Professor, Corresponding Member of the Russian Academy of Sciences

俄罗斯联邦, Irkutsk; Irkutsk; Irkutsk

Simon S. Poloyan

Children’s Regional Clinical Hospital; Irkutsk State Medical University

Email: simonpoloyan@ya.ru
ORCID iD: 0000-0001-7042-6646
俄罗斯联邦, Irkutsk; Irkutsk

Eduard V. Sapukhin

Children’s Regional Clinical Hospital

Email: sapukhin@yandex.ru
ORCID iD: 0000-0001-5470-7384

MD, Cand. Sci. (Medicine)

俄罗斯联邦, Irkutsk

Aleksey S. Strashinsky

Children’s Regional Clinical Hospital

Email: Leksus-642@yandex.ru
ORCID iD: 0000-0002-1911-4468

MD

俄罗斯联邦, Irkutsk

Marina V. Makarochkina

Children’s Regional Clinical Hospital

Email: m.makarochkina@gmail.com
ORCID iD: 0000-0001-8295-6687
SPIN 代码: 4600-4071

MD

俄罗斯联邦, Irkutsk

Andrey A. Marchuk

Children’s Regional Clinical Hospital

Email: maa-ped20@yandex.ru
ORCID iD: 0000-0001-9767-0454

MD

俄罗斯联邦, Irkutsk

Alexander P. Rozhanskii

Irkutsk State Medical University

Email: alexanderozhanski@mail.ru
ORCID iD: 0000-0001-7922-7600

MD

俄罗斯联邦, Irkutsk

Anton A. Byrgazov

Children’s Regional Clinical Hospital

Email: byrgazov.ant-doc38@yandex.ru
ORCID iD: 0000-0002-9195-5480

MD

俄罗斯联邦, Irkutsk

Sergey A. Muravev

Irkutsk State Medical University

Email: muravev1999sergey@mail.ru
ORCID iD: 0000-0003-4731-7526

MD

俄罗斯联邦, Irkutsk

Artem N. Narkevich

South Ural State Medical University; Professor V.F. Voino-Yasenetsky Krasnoyarsk State Medical University

Email: narkevichart@gmail.com
ORCID iD: 0000-0002-1489-5058

MD, Dr. Sci. (Medicine), Assistant Prifessor

俄罗斯联邦, Chelyabinsk; Krasnoyarsk

参考

  1. Ellison JS, Lendvay TS. Robot-assisted ureteroureterostomy in pediatric patients: current perspectives. Robot Surg. 2017;4:45–55. doi: 10.2147/RSRR.S99536
  2. Jain P, Parelkar S, Shah H, et al. Uncrossed complete ureteral duplication with dysplastic lower moiety: a violation of the Weigert–Meyer law. J Pediatr Urol. 2008;4(5):404–406. doi: 10.1016/j.jpurol.2008.01.210
  3. Chacko JK, Koyle MA, Mingin GC, Furness PD. Ipsilateral ureteroureterostomy in the surgical management of the severely dilated ureter in ureteral duplication. J Urol. 2007;178(4S):1689–1692. doi: 10.1016/j.juro.2007.05.098
  4. Grimsby GM, Merchant Z, Jacobs MA, Gargollo PC. Laparoscopic-assisted ureteroureterostomy for duplication anomalies in children. J Endourol. 2014;28(10):1173–1177. doi: 10.1089/end.2014.0113
  5. Kutikov A, Nguyen M, Guzzo T, et al. Laparoscopic and robotic complex upper-tract reconstruction in children with a duplex collecting system. J Endourol. 2007;21(6):621–624. doi: 10.1089/end.2006.0227
  6. Cohen SA, Juwono T, Palazzi KL, et al. Examining trends in the treatment of ureterocele yields no definitive solution. J Pediatr Urol. 2015;11(1):29.e1–29.e6. doi: 10.1016/j.jpurol.2014.09.001
  7. Le H-K, Chiang G. Long-term management of ureterocele in duplex collecting systems: Reconstruction implications. Curr Urol Rep. 2018;19(2):14. doi: 10.1007/s11934-018-0758-3
  8. Ellsworth PI, Lim DJ, Walker RD, et al. Common sheath reimplantation yields excellent results in the treatment of vesicoureteral reflux in duplicated collecting systems. J Urol. 1996;155(4):1407–1409. doi: 10.1016/S0022-5347(01)66293-1
  9. Joyeux L, Lacreuse I, Schneider A, et al. Long-term functional renal outcomes after retroperitoneoscopic upper pole heminephrectomy for duplex kidney in children: a multicenter cohort study. Surg Endosc. 2017;31(3):1241–1249. doi: 10.1007/s00464-016-5098-0
  10. Jayram G, Roberts J, Hernandez A, et al. Outcomes and fate of the remnant moiety following laparoscopic heminephrectomy for duplex kidney: a multicenter review. J Pediatr Urol. 2011;7(3):272–275. doi: 10.1016/j.jpurol.2011.02.029
  11. Rickwood AM, Reiner I, Jones M, Pournaras C. Current management of duplex-system ureteroceles: experience with 41 patients. Br J Urol. 1992;70(2):196–200. doi: 10.1111/j.1464-410X.1992.tb15703.x
  12. Lashley DB, McAleer IM, Kaplan GW. Ipsilateral ureteroureterostomy for the treatment of vesicoureteral reflux or obstruction associated with complete ureteral duplication. J Urol. 2001;165(2):552–554. doi: 10.1097/00005392-200102000-00067
  13. Abdelhalim A, Chamberlin JD, Truong H, et al. Ipsilateral ureteroureterostomy for ureteral duplication anomalies: predictors of adverse outcomes. J Pediatr Urol. 2019;15(5):468.e1–468.e6. doi: 10.1016/j.jpurol.2019.05.016
  14. Kagantsov IM, Sizonov VV, Dubrov VI, et al. First experience of the uretero-ureteroanastomosis (ureteropyeloanastomosis) in children with complete ureteral duplication. Urology Herald. 2017;5(4):29–38. EDN: ZXWCYX doi: 10.21886/2308-6424-2017-5-4-29-38
  15. Chandrasekharam VVS, Jayaram H. Laparoscopic ipsilateral ureteroureterostomy for the management of children with duplication anomalies. J Indian Assoc Pediatr Surg. 2015;20(1):27–31. doi: 10.4103/0971-9261.145442
  16. Gerwinn T, Gnannt R, Weber DM, et al. Laparoscopic ureteroureterostomy vs. common sheath ureteral reimplantation in children with duplex kidney anomalies. Front Pediatr. 2021;9:637544. doi: 10.3389/fped.2021.637544
  17. Leavitt DA, Rambachan A, Haberman K, et al. Robot-assisted laparoscopic ipsilateral ureteroureterostomy for ectopic ureters in children: description of technique. J Endourol. 2012;26(10):1279–1283. doi: 10.1089/end.2012.0041
  18. Lee NG, Corbett ST, Cobb K, et al. Bi-Institutional comparison of robot-assisted laparoscopic versus open ureteroureterostomy in the pediatric population. J Endourol. 2015;29(11):1237–1241. doi: 10.1089/end.2015.0223
  19. Biles MJ, Finkelstein JB, Silva MV, et al. Innovation in robotics and pediatric urology: robotic ureteroureterostomy for duplex systems with ureteral ectopia. J Endourol. 2016;30(10):1041–1048. doi: 10.1089/end.2015.0645
  20. Kagantsov IV, Shchedrov DN, Sizonov VV, et al. Ureteral stump syndrome after ureteroureteroanastomosis, heminephrectomy and nephrectomy in children. Urology Herald. 2020;8(4):32–43. EDN: SKHIWN doi: 10.21886/2308-6424-2020-8-4-32-43

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1. JATS XML
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2. Fig. 1. Сomputed tomography urography images demonstrating UUUT with lower segment dilatation: а — coronal section; b — threedimensional reconstruction

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3. Fig. 2. MCUG image demonstrating reflux into the lower segment (indicated by arrow)

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4. Fig. 3. Ureters of the lower (1) and upper (2) segments of the right kidney after dissection

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5. Fig. 4. Application of anchor transparietal sutures to the wall of the recipient ureter

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6. Fig. 5. Transverse section of the lower segment ureter

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7. Fig. 6. Longitudinal dissection of the anteromedial wall of the recipient ureter

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8. Fig. 7. Final view of robot-assisted end-to-side interureteral anastomosis

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