【摘要】 目的:儿童肾盂输尿管连接部梗阻(ureteropelvic junction obstruction, UPJO)可引发肾积水、肾功能障碍及尿路感染(urinary tract infection, UTI)。机器人辅助腹腔镜肾盂成形术(robot-assisted laparoscopic pyeloplasty, RALP)作为微创技术，较传统腹腔镜具有放大视野、操作精准等优势，但其临床有效性和安全性在儿童UPJO患者中尚不明确。本研究旨在评估RALP治疗儿童UPJO的可行性、安全性，并分析影响预后的危险因素。方法:回顾性分析2020年5月—2022年11月在贵州省人民医院小儿外科确诊UPJO并接受RALP的患儿的临床资料，按照纳入和排除标准筛选后共计102例，其中男81例(78.64%),女21例(20.39%)。中位年龄为36(0,156)月，中位体重为14(4.5,52.2) kg。针对纳入患儿的术前、术后相关指标，我们通过对比分析术前与术后1、3、6个月的肾积水情况、分肾功能来探讨手术的有效性；通过分析术前及术后的血白细胞、C反应蛋白(C-reactive protein, CRP)、肌酐、尿素氮及肾小球滤过率(glomerular filtration rate, GFR)等指标变化来评估手术的安全性；另外我们将高于总手术时间及肾盂吻合时间均值的部分病例单独进行危险因素分析，以求寻找造成手术时间延长的不良危险因素。结果:术后1、3、6个月肾盂分离度(anteroposterior pelvic diameter, APD)较术前显著下降(P<0.001),但肾皮质厚度无变化；分侧肾GFR在术前与术后6个月均差异无统计学意义(P>0.05)。手术前后白细胞、肌酐、CRP等指标比较差异无统计学意义(P>0.05),无重大并发症或术中出血事件。单中心数据显示，RALP操作可控，学习曲线平缓，平均手术时间<2 h,住院时间缩短至3～5 d。结论:RALP在缓解儿童肾积水体积、保护肾功能方面效果显著，同时能有效降低术后感染、急性肾功能损伤及术中出血风险，具有较高的临床安全性。更多还原

【Abstract】 Objective: Ureteropelvic junction obstruction(UPJO) in children can lead to hydronephrosis, renal dysfunction, and urinary tract infection(UTI). Robot-assisted laparoscopic pyeloplasty(RALP), as a minimally invasive technique, offers advantages such as magnified vision and precise operation compared to conventional laparoscopy. However, its clinical efficacy and safety in pediatric UPJO patients remain unclear. This study aims to evaluate the feasibility and safety of RALP for UPJO and to analyze risk factors affecting prognosis. Methods: A retrospective analysis was conducted on the clinical data of children diagnosed with UPJO and subjected to RALP in the Department of Pediatric Surgery, Guizhou Provincial People’s Hospital, between May 2020 and November 2022. A total of 102 cases were included based on the established inclusion and exclusion criteria, comprising 81 males(78.64%) and 21 females(20.39%). The median age was 36(0, 156) months, and the median body weight was 14(4.5, 52.2) kg. To evaluate the efficacy of the procedure, preoperative and postoperative indicators were compared, specifically focusing on the degree of hydronephrosis and split renal function at 1, 3, and 6 months postoperatively. The safety of the surgery was assessed by analyzing changes in laboratory parameters, including white blood cell count, C-reactive protein(CRP), creatinine, blood urea nitrogen, and glomerular filtration rate(GFR), before and after the operation. Furthermore, cases with total operative time and pyeloureteral anastomosis time exceeding the respective mean values were subjected to a separate risk factor analysis to identify potential adverse factors contributing to prolonged surgical duration. Results: Anteroposterior pelvic diameter(APD) significantly decreased at 1, 3, and 6 months postoperatively compared to preoperative values(P<0.001), while renal cortical thickness showed no significant change. No statistically significant difference was observed in split renal GFR between preoperative and 6-month postoperative measurements(P>0.05). No significant abnormalities were detected in white blood cell count, creatinine, or CRP levels before and after surgery(P>0.05). There were no major complications or significant intraoperative bleeding events. Single-center data indicated that RALP was controllable with a shallow learning curve. The mean operative time was less than 2 hours, and the length of hospital stay was shortened to 3-5 days. Conclusion: Da Vinci robot-assisted pyeloplasty in children demonstrates significant effectiveness in reducing hydronephrosis and preserving renal function. It also effectively reduces the risks of postoperative infection, acute kidney injury, and intraoperative bleeding, showing high clinical safety.更多还原