摘要目的 探讨腹腔镜治疗儿童不完全性重复肾伴下肾积水并保留肾脏的手术方法和临床效果.方法 回顾性分析2012年6月至2015年8月收治的行腹腔镜治疗不完全性重复肾伴下肾积水并保留肾脏的4例患儿的临床资料.4例均为男性,年龄4.5 ～44.0个月,平均28.3个月.左侧3例,右侧1例.4例患儿均通过逆行泌尿系造影检查明确诊断为不完全性重复肾,下肾肾盂输尿管连接处梗阻伴肾积水;超声提示积水逐渐加重.根据患儿术中具体情况制定个体化手术方案.观察术中、术后并发症情况及随访结果等指标.结果 4例均通过腹腔镜顺利完成手术,其中2例采用下肾肾盂与上肾输尿管端侧吻合术,1例采用下肾肾盂与汇合点以下输尿管端侧吻合、上肾输尿管与下肾肾盂楔形吻合的手术方式,1例采用离断式肾盂输尿管成形术.4例术后均放置肾周引流管.手术时间87 ～150 min,平均127 min.术中出血量较少,平均约10 ml.术后1例患儿失访,其余3例随访时间5～41个月.随着随访时间的延长,积水明显缓解,且术后上肾段未发生继发性肾积水.结论 对于重复肾肾功能较好的积水肾段,应积极保留.腹腔镜手术治疗儿童不完全性重复肾伴下肾积水并保留肾脏是一种安全有效的方法.手术方式的选择应根据具体的解剖结构制定个体化方案.术后应常规放置肾周引流管.

abstractsObjective To discuss the efficacy of laparoscopic reconstructive surgery for lower moiety hydronephrosis with incomplete duplex kidney.Methods We retrospectively reviewed the clinical data of the 4 patients who had surgery from 2012 to 2015, with a diagnosis of lower moiety hydronephrosis resulted from ureteropelvic junction obstruction in duplex system.Demographic, diagnostic, procedural and follow-up data were recorded.Results All laparoscopic surgeries were completed successfully.Two patients were treated with lower-upper moiety pyeloureterostomy, one with dismembered pyeloplasty and upper-lower ureteropyelostomy and another with lower-moiety dismembered pyeloplasty.A peripelvic catheter was routinely left in all four patients.The surgery time was 87-150 min, mean time was 127min.The average bleeding amount during surgery was about 10 ml.One patient presented with urinary extravasation post-surgery.One patient was lost to follow-up.Mean follow-up was 19 months (range 5 to 41 months).During follow-up, the degree of hydronephrosis decreased gradually.Conclusions Laparoscopic reconstructive surgery for hydronephrosis with duplex kidney could be minimal invasive and effective.Routinely placing a peripelvic catheter drainage is recommended.