| Objective: To research the outcome of transumbilical laparoendoscopic single-site heminephroureterectomy(U-LESS-H)with conventional open heminephroureterectomy(C-H)for duplex kidney in children.Comparatively analyzes the efficacy and feasibility,safety of the two procedure.Evaluates the clinical application of LESS technique for duplex kidney in children.Methods: A parallel controlled study analysis the clinical data of children undergone heminephroureterectomy from March 2013 to September 2015 in one children's hospital.Be hospitalized,the patients were divided into 2 different groups by odd and even outpatient service numbers.U-LESS-H group undergone the transumbilical laparoendoscopic single-site heminephroureterectomy.C-H group undergone the conventional open heminephroureterectomy.We collected the general data and the perioperative period data of patients,and the short-to mid-term efficacy were compared between the 2 groups.Results: From March 2013 to September 2015,62 children with duplication of kidney and ureter were treated.A total of 53 patients performed in 32 girls and 21 boys undergone heminephroureterectomy surgery were into groups.9 cases because of the need to continue to observe or undergone other procedure to be excluded.The mean age of 53 cases is 35.8±36.8 months.Preoperative examination left in 31 cases,14 cases to the right,bilateral in 8 cases.The operation was performed on the left side in 36 cases,right side in 16 cases and bilateral in 1 case.The upper pole heminephroureterectomy in 52 cases,the lower pole heminephroureterectomy in 1 case.There were 9 boys and 15 girls,mean age was 20.2±28.6 months in the U-LESS-H group,12 boys and 17 girls,mean age was 46.0±38.3 months in the C-H group.There was no statistically significant difference in gender composition,age and affected side(P>0.05).The accompanying symptoms of the U-LESS-H and C-H group: ureterocele were found in 10 and 12 cases respectively,vesicoureteral reflux(VUR)were found in 4 and 7 cases respectively,ectopic ureter orifice were found in 5 and 9 cases respectively,repeatedly urinary tract infection(UTI)were found in 7 and 8 cases respectively.There was 1 case conversion to open surgery and 2 cases added an additional port besides the umbilicus in U-LESSH group,and all occurred in the early stage of the study.Compared U-LESS-H group with C-H group: the operation time was 167.3±43.7 min and 137.0±28.8 min respectively(P=0.006);blood loss was 3.2±43.7 ml and 45.7±28.8 ml respectively(P=0.134);blood transfusion was in 4 and 6 cases respectively(P=0.709);time of resumption to a regular diet was 1.4±1.1 d and 1.4±1.5 d respectively(P=0.785);time of indwelling drainage tube was 4.1±2.0 d and 5.1±1.6 d respectively(P=0.200);postoperative hospital stay was 8.6±2.2 d and 8.6±2.0 d respectively(P=0.725).The mean time of follow-up is 18.2 months(2-31 months).Complications after surgery between group U-LESS-H and C-H included: urinary tract infection(UTI)with fever(3 VS.2,P=0.824),hypertension(0 VS.2 P=0.495),ureteral stump syndrome(1 VS.3,P=0.745),Urinoma(1 VS.0,P=0.453)and renal functional loss(0 VS.1,P=1.000).Conclusion:(1)The transumbilical laparoendoscopic single-site Heminephroureterectomy(U-LESS-H)is feasible,effective and safe in experienced pediatric urologic surgeons and medical institutions.(2)The results of U-LESS-H can reach C-H procedure.(3)The U-LESS-H procedure has better cosmetic results and the advantages of reduce the surgical trauma than the C-H procedure. |
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