微创医学

目的探讨机器人辅助腹腔镜部分肾切除术治疗小儿重复肾的临床疗效和安全性。方法回顾性分析2022年2月至2023年8月广西医科大学第一附属医院采用机器人手术治疗的4例重复肾患儿的临床资料。患儿术前均经泌尿系统造影、肾核素扫描等检查明确诊断为重复肾畸形且患侧上位肾功能<10%，其中男1例、女3例，月龄12～28个月；完全型重复肾2例，不完全型重复肾2例。收集并分析4例患儿的手术时长、术中出血量及治疗结局等情况。结果 4例均通过机器人辅助腹腔镜手术系统顺利完成手术，手术时间109～164 min，平均手术时间136 min，术中出血量5～130 mL，平均出血量为43.8 mL，术后住院时间4～8 d，平均住院时间为5.8 d，术后均无尿漏感染、肠梗阻等并发症。术后随访12～22个月，定期复查患侧肾功能，术后半年1例患儿出现肾功能下降，经随访观察术后1年复查患侧肾功能好转，其余3例术后肾功能较术前明显好转。结论机器人辅助腹腔镜部分肾切除术治疗小儿重复肾安全可靠、效果满意，尤其在精细解剖和快速康复方面优势明显，为小儿重复肾的手术治疗提供了新选择。

Objective To investigate the clinical efficacy and safety of robot-assisted laparoscopic partial nephrectomy for the treatment of duplex kidney in pediatric patients. Methods A retrospective analysis was conducted on the clinical data of 4 children with duplex kidneys who underwent robotic surgery in the First Affiliated Hospital of Guangxi Medical University from February 2022 to August 2023. Diagnosed via urography and renal radionuclide scanning, all patients presented with duplex kidneys and renal function of less than 10%. Among them, there was 1 male and 3 females, whose ages spanned from 12 to 28 months. Moreover, 2 cases were characterized as complete duplex kidneys, while the remaining 2 cases were incomplete duplex kidneys. The operative duration, intraoperative blood loss, and treatment outcomes of the four pediatric patients were collected and analyzed. Results For all four cases, the surgeries were successfully carried out using the robot-assisted laparoscopic surgery system. The operation time was 109 to164 minutes, with an average of 136 minutes. The intraoperative blood loss was 5 to 130 mL, with an average of 43.8 mL. The postoperative hospital stay was 4 to 8 days, with an average of 5.8 days. No postoperative complications such as urinary leakage, infection, or intestinal obstruction were observed. All patients were under follow-up for 12 to 22 months, during which the renal function of the affected side was regularly examined. Half a year after the operation, 1 case showed a decline in renal function, but a reexamination after one year of follow-up revealed an improvement in the renal function of the affected side. As for the other three patients, their renal functions improved remarkably after the operation compared with that before operation. Conclusion Robot-assisted laparoscopic partial nephrectomy is a safe, reliable, and effective approach for treating duplex kidneys in pediatric patients. It excels particularly in detailed anatomical dissection and enabling swift recovery, thus offering a novel alternative for the surgical management of pediatric duplex kidneys.