摘要目的:总结机器人辅助腹腔镜肾盂成形术在小儿小肾盂，即肾盂前后径(anteroposterior diameter，APD)<2.5 cm的输尿管肾盂连接部梗阻(ureteropelvic junction obstruction，UPJO)患儿中的应用经验。方法:回顾性分析2018年3月至2019年10月收治的行达芬奇机器人辅助腹腔镜下肾盂成形术(robotic-assistant laparoscopic pyeloplasty，RALP)的12例小肾盂UPJO患儿的临床资料。其中，男7例，女5例；年龄4～15岁，平均7岁；患侧为左侧9例，右侧3例。术前1～7 d患儿B型超声检查提示APD<2.5 cm，术前核磁共振或CT尿路造影均提示为输尿管肾盂连接处梗阻，过往腹痛时期本院或当地超声检查示APD>3.5 cm。核素检查提示患儿患肾功能有不同程度的下降，患肾分肾功能在6%～43%。结果:12例RALP手术均顺利完成，无中转开放手术者。其中3例为单纯扭曲狭窄所致UPJO，3例为输尿管肾盂连接部(ureteropelvic junction，UPJ)处息肉的病变，4例为异位血管压迫，1例为UPJ处结石嵌顿伴感染，1例为腔静脉后输尿管。手术时间115～225 min，平均165 min；其中输尿管肾盂吻合时间40～60 min，平均50 min。术中无合并症，平均出血量<10 ml。患儿随访2～22个月，平均12个月。本组术后APD为(1.16±0.82)cm，与术前(1.87±0.57)cm比较，差异有统计学意义( P<0.05)。 结论:机器人辅助腹腔镜下肾盂成形术可在小儿小肾盂UPJO中应用并能取得较好结果，操作相对较易掌握，临床应用前景较好。

abstractsObjective:To summarize the experience of robotic-assistant laparoscopic pyeloplasty (RALP) for ureteropelvic junction obstruction (UPJO) with small pelvis in children.Methods:A retrospective analysis was performed on clinical data of 12 UPJO children (small pelvis) undergoing RALP from March 2018 to October 2019. Their clinical presentations, operative approaches and follow-up data were analyzed. There were 7 boys and 5 girls with a mean age of 7(4-15) years. The involved side was left ( n=9) and right ( n=3). Ultrasound at 1-7 days preoperatively indicated anterioposterior diameter (APD)<2.5 cm and magnetic resonance urography or computed tomography urogram (MRU/CTU) indicated obstruction at ureteropelvic junction. Ultrasound indicated APD>3.5 cm during an on set of abdominal pain. And radionuclide examination hinted at different declining levels of renal function and the function of affected kidney ranged from 6% to 43%. Results:RALP was performed all successfully without a conversion into open surgery. The pathogenesis was simple stricture or torsion ( n=3), polyps ( n=3), ectopic vascular compression ( n=4), calculus incarceration with infection ( n=1) and postcaval ureter ( n=1). The average operative duration was 165(115-225) min and the average ureteropelvic anastomosis time 50(40-60) min. There were no obvious intraoperative complications and the mean volume of blood loss was <10 ml. The average follow-up period was 12(2-22) months. The mean preoperative value of APD was (1.87±0.57)cm and the mean postoperative value of APD (1.16±0.82)cm ( P<0.05). Conclusions:Robot-assisted laparoscopic pyeloplasty may be employed for pediatric UPJO with small renal pelvis (APD<2.5 cm). Such a technique is easy to learn and clinical application prospects are excellent.