| Objective To investigate the clinical value and significance of laparoscopy combined with computer-assisted surgery system Hisense CAS in pediatric duplex kidney.Methods The clinical date of 52 children(55 sides)who underwent laparoscopic kidney and ureteral resection surgery in the affiliated hospital of Qingdao university and three other hospitals,from January 2015 to October 2019 in Qingdao university hospital were retrospectively analyzed.Urinary system ultrasound and enhanced computed tomographic urography examination were performed before the operation.Among them,30 children(31 sides)underwent three-dimensional reconstruction of Hisense CAS based on CTU inspection were used as the experimental group.Twenty-two children(24 sides)without 3D reconstruction were used as the control group.All children underwent laparoscopic repeated nephrectomy,and data were collected and compared on operation time,intraoperative blood loss,correct intraoperative identification of vessels with repeated renal variation,placement of peritoneal drainage tube,total postoperative drainage volume,postoperative hospital stay and incidence of intraoperative and postoperative complications.Results1.Among the 52 cases,51 underwent laparoscopic lower renal ureterectomy,and 1 case was transferred to open surgery.The children with bilateral renal duplication were treated separately.Both intraoperative and postoperative pathology indicated that the kidney and ureter were malformed.All children were followed up regularly for(5 ～ 24)months after operation.2.According to whether Hisense CAS 3D reconstruction was performed or not,52 kids was divided into two groups.The control group had 22 children(24-side surgery),and the experimental group included 30 children(31-side surgery).There were 20 male children and 32 female children,with an average age of(6.14±2.09)months.There were 31 of left renal duplication,15 cases of right renal duplication,and 3 cases of bilateral renal duplication.Among them,1 case was inferior kidney repeat kidney,the rest were superior kidney.All the 52 children with renal duplication were combined with hydronephrosis and giant ureter.At the same time,cystoureteral reflux occurred in 13 cases.There were 19 cases of ureteral terminal cyst.There was no significant difference in the general data of gender,age,measurement,concomitant symptoms and surgical indications between the control group and the experimental group.3.The three-dimensional CAS reconstruction image of the test group accurately provided information such as the size,position,adjacent relationship and Vascular variation of the repeat kidney which was verification by the intraoperative exploration.The operation time of the experimental group was(107.94±12.12)min and the intraoperative blood loss was(6.59±3.69)mL.The operation time of the control group had an average of(122.33±14.12)min,and the intraoperative blood loss was(12.38±5.46)m L.There were statistically significant differences between the two groups.The accuracy rate of primary identification of variant vascular in repeated kidney in the experimental group was 96.77%,however,it was 66.67% in the other group.Hence,the differences were statistically significant.The postoperative hospital stay in the experimental and control group were(6.13±1.61 vs 6.54±1.84)d.There were 20 cases indwelling plasma drainage tube in the test group,however there were 17 patients fitting with drainage tube in the control group.The differences were not statistically distinguishing.The incidence of intraoperative and postoperative complications in the test group was 13.33%.The complication rate of the control group was40.91%.There was no statistically significant.Conclusion The Hisense CAS three-dimensional reconstruction can be used for diagnostic analysis,surgical planning and intraoperative real-time navigation in the repeated nephrectomy which achieving accurate resection of the repeated kidney and ureter.under the laparoscope aiming to improve the safety and accuracy of the operation. |
PDF Full Text Request