摘要目的:探讨吲哚菁绿（ICG）近红外荧光（NIRF）显影技术在儿童重复肾机器人辅助腹腔镜半肾切除术中的应用效果。方法:回顾性分析2023年12月至2024年9月贵州省人民医院收治的7例重复肾患儿的病例资料，男3例，女4例。中位年龄36（2，132）个月。重复肾均位于肾上极，左侧5例，右侧2例。7例均有肾积水加重史，其中4例有泌尿系感染史，1例伴正常排尿期外滴尿。术前行泌尿系增强CT、利尿性肾动态显像（SPECT）、排尿性膀胱尿路造影检查确诊。1例为输尿管异位开口，1例为输尿管囊肿开窗术后反复泌尿系感染，5例为输尿管末端梗阻。7例检查均提示重复上半肾分肾功能< 10%。7例均应用ICG-NIRF显影技术行机器人辅助腹腔镜重复肾半肾切除术。术中ICG荧光显影分3次：经下半肾输尿管置入导管，第1次注入ICG后，下半肾输尿管出现绿色荧光显影，在荧光模式引导下解剖游离上、下位输尿管；第2次静脉注射ICG显示供应上半肾的血管，阻断上半肾的供血血管；第3次静脉注射ICG后，灌注正常的下半肾荧光显影，缺血的上半肾无显影，沿上下半肾解剖分界线切除上半肾。结果:本组7例手术均顺利完成，手术时间（155.1 ± 22.7）min；术中出血量（12.5 ± 8.7）ml；术后住院时间（5.2 ± 1.7）d。术后随访时间（9.2 ± 3.5）个月，术前的泌尿系感染、正常排尿期外滴尿等症状消失。术后无输尿管残端积液、漏尿病例。术后3个月复查SPECT未提示下半肾功能丢失。结论:儿童重复肾机器人辅助腹腔镜半肾切除术中应用ICG-NIRF显影技术易于操作、安全可行，其主要优势是可以清楚识别正常输尿管、无功能肾的血管、上下半肾的分界线，可指导优化手术策略。

abstractsObjective:Exploring the efficacy of indocyanine green（ICG）near-infrared fluorescence（NIRF）imaging technology in robotic-assisted laparoscopic partial nephrectomy for children with duplicated kidneys.Methods:A retrospective analysis was conducted on the medical records of 7 children with duplicated kidneys admitted to Guizhou Provincial People's Hospital from December 2023 to September 2024，including 3 males and 4 females. The patients with a median age of 36（2，132）months. All cases of duplicated kidneys were located at the renal pole，with 5 on the left side and 2 on the right side. All 7 patients had a history of worsening hydronephrosis，with 4 having a history of urinary tract infection and 1 accompanied by urinary incontinence（urine leakage outside the normal voiding period）. Preoperative diagnosis was confirmed via enhanced CT of the urinary tract，diuretic renal dynamic imaging（SPECT），and voiding cystourethrography. One case had an ectopic ureteral opening. One case had recurrent urinary tract infections following ureteral cyst fenestration surgery，and five cases had terminal ureteral obstruction. All seven cases showed that the functional capacity of the duplicated upper kidney was <10%. All 7 cases underwent robot-assisted laparoscopic repeated nephrectomy of the upper kidney using ICG-NIRF technology. Intraoperative ICG fluorescence imaging was performed in three stages：a catheter was inserted through the lower kidney ureter，and after the first injection of ICG，green fluorescence was observed in the lower kidney ureter. Under fluorescence guidance，the upper and lower ureters were anatomically dissected；The second ICG injection via intravenous administration revealed the vessels supplying the upper kidney，and the blood supply to the upper kidney was blocked；After the third ICG injection via intravenous administration，the normal lower kidney showed fluorescence imaging，while the ischemic upper kidney did not. The upper kidney was resected along the anatomical boundary between the upper and lower kidneys.Results:All 7 surgeries were successfully completed，with an average surgical time of（155.1 ± 22.7）min；Intraoperative blood loss was（12.5 ± 8.7）ml；postoperative hospital stay was（5.2 ± 1.7）days. Postoperative follow-up duration was（9.2 ± 3.5）months，with preoperative concomitant urinary tract infection and post-micturition dribbling symptoms resolved. No cases of ureteral stump effusion or urinary leakage were observed postoperatively. At the 3-month postoperative follow-up SPECT examination，no loss of lower kidney function was detected.Conclusions:The application of ICG-NIRF imaging technology in robotic-assisted laparoscopic heminephrectomy for children with duplicated kidneys is easy to perform and safe. Its main advantage is the ability to clearly identify normal ureters，blood vessels of non-functional kidneys，and the boundary between the upper and lower halves of the kidney，thereby guiding the optimization of surgical strategies.