Детская хирургия. Журнал им. Ю.Ф. Исакова. 2022; 26: 135-141
Лапароскопическое перемещение аберрантных почечных сосудов в лечении врождённого гидронефроза
https://doi.org/10.55308/1560-9510-2022-26-3-135-141Аннотация
Введение. Цель работы – оценка ближайших результатов лапароскопического перемещения аберрантных почечных сосудов как эффективной альтернативы пиелопластике при лечении детей с внешней обструкцией пиелоуретерального соединения.
Материал и методы. Лапароскопическая техника сосудистого перемещения была применена у 5 детей с гидронефрозом, вызванным добавочными нижнеполярными сосудами. Предоперационное диагностическое обследование включало: ультразвуковое / допплеровское сканирование, радиоизотопное сканирование почек и контрастную компьютерную урографию. Все пациенты имели интермиттирующий гидронефроз (диапазон 24,0–36,0 мм) и обструктивный паттерн при выполнении реносцинтиграфии. Для того, чтобы произвести селекцию пациентов, у которых можно выполнить сосудистое перемещение, в начале операции выполняли нагрузочный диуретический тест. В ходе операции добавочные почечные сосуды мобилизовались и перемещались вверх, где они фиксировались путем «окутывания» тканью почечной лоханки.
Результаты. Среднее время операции составило 59,0 ± 10,2 мин, а средняя продолжительность пребывания в стационаре — 3,6 ± 0,5 дня. Осложнения в раннем периоде наблюдений отсутствовали. При последующем наблюдении (диапазон 6–24 мес) у всех пациентов произошло снижение степени гидронефроза и улучшение выделительной функции на ренограмме.
Заключение. Предварительные результаты исследования продемонстрировали безопасность и эффективность лапароскопического перемещения аберрантных почечных сосудов для лечения гидронефроза. Тщательный отбор пациентов посредством интраоперационных функциональных тестов является важным шагом для подтверждения показаний к этой процедуре и поддержания высокого уровня успеха процедуры. Любые опасения по поводу наличия дополнительного внутреннего стеноза пиелоуретерального соединения, безусловно, должны трансформировать хирургическое вмешательство в классическую пиелопластику.
Список литературы
1. Wein A. J. Anomalies and surgery of the ureteropelvic junction in children. In: Carr MC and El-Ghoneimi A (eds) Campbell-Walsh urology. Philadelphia, PA: W. B. Saunder; 2007.
2. Panek W., Jong T. P. V. M., Szydełko T., Chrzan R. Management of crossing vessels in children and adults: A multi-center experience with the transperitoneal laparoscopic approach. Adv Clin Exp Med. 2019; 28 (6):777–82.
3. Anderson J. C., Hynes W. Retrocaval ureter; a case diagnosed preoperatively and treated successfully by a plastic operation. Br J Urol. 1949; 21: 209–14.
4. Каганцов И. М. Лапароскопическая пиелопластика – современный стандарт лечения врожденного гидрофнероза у детей // И. М. Каганцов, А. Е. Минин, И. А. Санников // Российский вестник детской хирургии, анестезиологии и реаниматологии. – 2012. – 2: 15–20. – Kagantsov I .M., Minin A. E., Sannikov I. A. Laparoscopic pyeloplasty is the modern standard of care for congenital hydrophnerosis in children. Rossiĭskiĭ vestnik detskoĭ xirurgii, anesteziologii i reanimatologii. 2012; 2: 15–20. (In Russian)
5. Врублевский C. Г. Эндохирургическая пиелопластика у детей как эволюция золотого стандарта / С. Г. Врублевский [и др.] // Детская хирургия. – 2013. – 6: 4–6. – Vrublevsky S. G., Gurevich A. I., Vrublevskaya E. N., Al-Mashat N. A., Shmyrov O. S., Zakharov A. I., Sklyarova T. A., Koroleva O. V., Efimova V. I. Endosurgical pyeloplasty in children as the evolution of the gold standard. Detskaya khirurgiya. 2013; 6: 4–6. (In Russian)
6. Бондаренко С. Г. Лапароскопическая пиелопластика у детей / С. Г. Бондаренко, Г. Г. Абрамов // Детская хирургия. – 2013. – 6: 7–10. – Bondarenko S. G., Abramov G. G. Laparoscopic pyeloplasty in children. Detskaya khirurgiya. 2013; 6: 7–10. (In Russian)
7. Chandrasekharam V. V. S., Babu R. A systematic review and meta-analysis of conventional laparoscopic versus robot-assisted laparoscopic pyeloplasty in infants. J Pediatr Urol. 2021; 17 (4): 502–10.
8. Tanabe K., Nakamura S., Hyuga T., Kubo T., Kawai S., Nakai H. Retroperitoneoscopy-assisted dismembered pyeloplasty with single-site plus one port in older children with congenital hydronephrosis. Asian J Endosc Surg. 2022; 15 (2): 335–43. https://doi.org/10.1111/ases.13021
9. Andolfi C., Adamic B., Oommen J., Gundeti M. S. Robot-assisted laparoscopic pyeloplasty in infants and children: is it superior to conventional laparoscopy? World J Urol. 2020; 38 (8): 1827–33.
10. Hellström J., Giertz G., Lindblom K. Pathogenesis and treatment of hydronephrosis. Presentedat VIII Congreso de la Sociedad International de Urologia. Paris, France; 1949.
11. Chapman T. L. Urology in outline. Edinburgh, London: Churchill Livingstone; 1959; 82.
12. Pesce C., Campobasso P., Costa L., et al. Ureterovascular hydronephrosis in children: is pyeloplasty always necessary? Eur Urol. 1999; 36: 71–4.
13. Peters C. A., Schlussel R. N., Retik A. B. Pediatric laparoscopic dismembered pyeloplasty. J Urol. 1995; 153: 1962–5.
14. Godbole P., Mushtaq I., Wilcox D. T., Duffy P. G. Laparoscopic transposition of lower pole vessels e “the vascular hitch”: an alternative to dismembered pyeloplasty for pelvi-ureteric junction obstruction in children. J Pediatr Urol. 2006; 2: 285–9.
15. Sakoda A., Cherian A., Mushtaq I. Laparoscopic transposition of lower pole crossing vessels ("vascular hitch") in pure extrinsic pelvi-ureteric junction obstruction in children. BJU Int. 2011; 108: 1364e8.
16. Singh R. R., Govindarajan K. K., Chandran H. Laparoscopic vascular relocation: alternative treatment for renovascular hydronephrosis in children. Pediatr Surg Int. 2010; 26: 717–20.
17. Gundeti M. S., Reynolds W. S., Duffy P. G., et al. Further experience with the vascular hitch (laparoscopic transposition of lower pole crossing vessels): an alternate treatment for pediatric ureterovascular ureteropelvic junction obstruction. J Urol. 2008; 180: 1832–6.
18. Esposito C., Bleve C., Escolino M., Caione P., Gerocarni Nappo S., Farina A., Caprio M. G., Cerulo M., La Manna A., Chiarenza S. F. Laparoscopic transposition of lower pole crossing vessels (vascular hitch) in children with pelviureteric junction obstruction. Transl Pediatr. 2016; 5 (4): 256–61.
19. Singh R. R., Govindarajan K. K., Chandran H. Laparoscopic vascular relocation: alternative treatment for renovascular hydronephrosis in children. Pediatr Surg Int. 2010; 26: 717–20.
20. Козлов Ю. А. Результаты лапароскопической пиелопластики у детей с гидронефрозом, вызванным внешними и внутренними причинами / Ю. А. Козлов [и др.] // Эндоскопическая хирургия. – 2021. – 27 (5): 19–28. – Kozlov Yu. A., Baradieva P. Zh., Cheremnov V. S., Ochirov C. B., Kovalkov K. A., Poloyan S. S., Kapuller V. M., Narkevich A. N. Results of laparoscopic pyeloplasty in children with hydronephrosis caused by external and internal causes. Endoskopicheskaya hirurgiya. 2021; 27 (5): 19–28. (In Russian)
21. Cain M. P., Rink R. C., Thomas A. C., et al. Symptomatic ureteropelvic junction obstruction in children in the era of prenatal sonography – is there a higher incidence of crossing vessels? Urology. 2001; 57: 338–41.
22. Chiarenza S. F., Bleve C., Fasoli L., Battaglino F., Bucci V., Novek S., Zolpi E. Ureteropelvic junction obstruction in children by polar vessels. Is laparoscopic vascular procedure a good solution? Single center experience on 35 consecutive patients. J Pediatr Surg. 2016; 51: 310–4.
23. Bombiński P., Brzewski M., Warchoł S., Gołębiowski M. One-phase split-bolus CT Urography – a novel approach to reduce radiation dose in diagnostics of congenital anomalies of kidneys and urinary tract in children. Dev Period Med. 2017; 21 (4): 402–7.
24. Wong M. C. Y., Piaggio G., Damasio M. B., Molinelli C., Ferretti S. M., Pistorio A., Ghiggeri G., Degl’Innocenti M. L., Canepa A., Incarbone V., Mattioli G. Hydronephrosis and crossing vessels in children: Optimization of diagnostic-therapeutic pathway and analysis of color Doppler ultrasound and magnetic resonance urography diagnostic accuracy. J Pediatr Urol. 2018; 14 (1): 68.e1–6.
25. Polok M., Borselle D., Toczewski K., Apoznański W., Patkowski D. Detection rate of crossing vessels in pediatric hydronephrosis: Transperitoneal laparoscopy versus open lumbotomy. Adv Clin Exp Med. 2019; 28 (11): 1507–11.
26. Schneider A., Gomes Ferreira C., Delay C., et al. Lower pole vessels in children with pelviureteric junction obstruction: laparoscopic vascular hitch or dismembered pyeloplasty? J Pediatr Urol. 2013; 9: 419–23.
27. Miranda M. L., Pereira L. H., Cavalaro M. A., et al. Laparoscopic transposition of lower pole crossing vessels (vascular hitch) in children with pelviureteric junction obstruction: how to be sure of the success of the procedure? J Laparoendosc Adv Surg Tech. 2015; 25: 847–51.
28. Szavay P., Heyne-Pietschmann M., Zundel S. M. Subpelvine Stenose / Kreuzendes Gefäß – kontra vascular hitch [Uretero-pelvic junction obstruction due to crossing pole vessel: contra vascular hitch]. Aktuelle Urol. 2020; 51: 121–6.
29. Kim J. K., Keefe D. T., Rickard M., Milford K., Lorenzo A. J., Chua M. E. Vascular hitch for paediatric pelvi-ureteric junction obstruction with crossing vessels: institutional analysis and systematic review with meta-analysis. BJU Int. 2022; 129 (6): 679–87. https://doi.org/10.1111/bju.15342
30. Al-Emadi I., Juricic M., Mouttalib S., Galinier P., Bouali O., Abbo O. Laparoscopic vascular hitch for polar vessels in pyeloureteric junction obstruction: medium-term follow-up of a monocentric experience. Eur J Pediatr Surg. 2021; 31 (3): 282–5.
31. Sizonov V. V., Shidaev A. H., Mayr J. M., Kogan M. I., Kagantsov I. M., Rostovskaya V. V. Transposition and fixation of lower pole crossing vessel in children with ureteropelvic junction obstruction: A STROBE-compliant study. Medicine (Baltimore). 2021; 100 (51): e28235. https://doi.org/10.1097/MD.0000000000028235
32. Villemagne T., Fourcade L., Camby C., Szwarc C., Lardy H., Leclair M. D. Long-term results with the laparoscopic transposition of renal lower pole crossing vessels. J Pediatr Urol. 2015; 11 (4): 174.e1–7.
Russian Journal of Pediatric Surgery. 2022; 26: 135-141
Laparoscopic treatment of vasorenal hydronephrosis in children using aberrant renal vessel transposition
https://doi.org/10.55308/1560-9510-2022-26-3-135-141Abstract
The purpose of this article is to assess the immediate results of laparoscopic transposition of aberrant renal vessels as an effective alternative to pyeloplasty in the treatment of children with external obstruction of the pyeloureteral junction.
Material and methods. The laparoscopic vascular transposition technique was used in 3 children with hydronephrosis caused by aberrant renal vessels. The preoperative diagnostic examination included: ultrasound / Doppler scanning, radioisotope renal scanning and contrast computed urography. Renoscintigraphy showed that all patients had intermittent hydronephrosis (24–36 mm) and an obstructive pattern. In order to select patients in whom vascular transposition is possible, the diuretic loading test was made at the beginning of the surgery. During the surgery, accessory renal vessels were mobilized and moved upward, where they were fixed by "wrapping" with renal pelvis tissue.
Results. The median operative time was 59.0±10.2 minutes, and the median hospital stay was 3.6±0.5 days. There were no complications at the early observation period. At the follow-up (6.0–24.0 months), all patients showed a decrease in the degree of hydronephrosis and an improvement in excretory function at the renogram.
Conclusion. Preliminary results of the study have demonstrated safety and efficacy of laparoscopic repositioning of aberrant renal vessels for the treatment of hydronephrosis. A careful selection of patients through intraoperative functional tests is an important step to confirm indications for this procedure and to maintain its high success rate. Any concerns about the presence of additional internal stenosis of the pyeloureteral junction, of course, should transform this surgical intervention into the classic pyeloplasty.
References
1. Wein A. J. Anomalies and surgery of the ureteropelvic junction in children. In: Carr MC and El-Ghoneimi A (eds) Campbell-Walsh urology. Philadelphia, PA: W. B. Saunder; 2007.
2. Panek W., Jong T. P. V. M., Szydełko T., Chrzan R. Management of crossing vessels in children and adults: A multi-center experience with the transperitoneal laparoscopic approach. Adv Clin Exp Med. 2019; 28 (6):777–82.
3. Anderson J. C., Hynes W. Retrocaval ureter; a case diagnosed preoperatively and treated successfully by a plastic operation. Br J Urol. 1949; 21: 209–14.
4. Kagantsov I. M. Laparoskopicheskaya pieloplastika – sovremennyi standart lecheniya vrozhdennogo gidrofneroza u detei // I. M. Kagantsov, A. E. Minin, I. A. Sannikov // Rossiiskii vestnik detskoi khirurgii, anesteziologii i reanimatologii. – 2012. – 2: 15–20. – Kagantsov I .M., Minin A. E., Sannikov I. A. Laparoscopic pyeloplasty is the modern standard of care for congenital hydrophnerosis in children. Rossiĭskiĭ vestnik detskoĭ xirurgii, anesteziologii i reanimatologii. 2012; 2: 15–20. (In Russian)
5. Vrublevskii C. G. Endokhirurgicheskaya pieloplastika u detei kak evolyutsiya zolotogo standarta / S. G. Vrublevskii [i dr.] // Detskaya khirurgiya. – 2013. – 6: 4–6. – Vrublevsky S. G., Gurevich A. I., Vrublevskaya E. N., Al-Mashat N. A., Shmyrov O. S., Zakharov A. I., Sklyarova T. A., Koroleva O. V., Efimova V. I. Endosurgical pyeloplasty in children as the evolution of the gold standard. Detskaya khirurgiya. 2013; 6: 4–6. (In Russian)
6. Bondarenko S. G. Laparoskopicheskaya pieloplastika u detei / S. G. Bondarenko, G. G. Abramov // Detskaya khirurgiya. – 2013. – 6: 7–10. – Bondarenko S. G., Abramov G. G. Laparoscopic pyeloplasty in children. Detskaya khirurgiya. 2013; 6: 7–10. (In Russian)
7. Chandrasekharam V. V. S., Babu R. A systematic review and meta-analysis of conventional laparoscopic versus robot-assisted laparoscopic pyeloplasty in infants. J Pediatr Urol. 2021; 17 (4): 502–10.
8. Tanabe K., Nakamura S., Hyuga T., Kubo T., Kawai S., Nakai H. Retroperitoneoscopy-assisted dismembered pyeloplasty with single-site plus one port in older children with congenital hydronephrosis. Asian J Endosc Surg. 2022; 15 (2): 335–43. https://doi.org/10.1111/ases.13021
9. Andolfi C., Adamic B., Oommen J., Gundeti M. S. Robot-assisted laparoscopic pyeloplasty in infants and children: is it superior to conventional laparoscopy? World J Urol. 2020; 38 (8): 1827–33.
10. Hellström J., Giertz G., Lindblom K. Pathogenesis and treatment of hydronephrosis. Presentedat VIII Congreso de la Sociedad International de Urologia. Paris, France; 1949.
11. Chapman T. L. Urology in outline. Edinburgh, London: Churchill Livingstone; 1959; 82.
12. Pesce C., Campobasso P., Costa L., et al. Ureterovascular hydronephrosis in children: is pyeloplasty always necessary? Eur Urol. 1999; 36: 71–4.
13. Peters C. A., Schlussel R. N., Retik A. B. Pediatric laparoscopic dismembered pyeloplasty. J Urol. 1995; 153: 1962–5.
14. Godbole P., Mushtaq I., Wilcox D. T., Duffy P. G. Laparoscopic transposition of lower pole vessels e “the vascular hitch”: an alternative to dismembered pyeloplasty for pelvi-ureteric junction obstruction in children. J Pediatr Urol. 2006; 2: 285–9.
15. Sakoda A., Cherian A., Mushtaq I. Laparoscopic transposition of lower pole crossing vessels ("vascular hitch") in pure extrinsic pelvi-ureteric junction obstruction in children. BJU Int. 2011; 108: 1364e8.
16. Singh R. R., Govindarajan K. K., Chandran H. Laparoscopic vascular relocation: alternative treatment for renovascular hydronephrosis in children. Pediatr Surg Int. 2010; 26: 717–20.
17. Gundeti M. S., Reynolds W. S., Duffy P. G., et al. Further experience with the vascular hitch (laparoscopic transposition of lower pole crossing vessels): an alternate treatment for pediatric ureterovascular ureteropelvic junction obstruction. J Urol. 2008; 180: 1832–6.
18. Esposito C., Bleve C., Escolino M., Caione P., Gerocarni Nappo S., Farina A., Caprio M. G., Cerulo M., La Manna A., Chiarenza S. F. Laparoscopic transposition of lower pole crossing vessels (vascular hitch) in children with pelviureteric junction obstruction. Transl Pediatr. 2016; 5 (4): 256–61.
19. Singh R. R., Govindarajan K. K., Chandran H. Laparoscopic vascular relocation: alternative treatment for renovascular hydronephrosis in children. Pediatr Surg Int. 2010; 26: 717–20.
20. Kozlov Yu. A. Rezul'taty laparoskopicheskoi pieloplastiki u detei s gidronefrozom, vyzvannym vneshnimi i vnutrennimi prichinami / Yu. A. Kozlov [i dr.] // Endoskopicheskaya khirurgiya. – 2021. – 27 (5): 19–28. – Kozlov Yu. A., Baradieva P. Zh., Cheremnov V. S., Ochirov C. B., Kovalkov K. A., Poloyan S. S., Kapuller V. M., Narkevich A. N. Results of laparoscopic pyeloplasty in children with hydronephrosis caused by external and internal causes. Endoskopicheskaya hirurgiya. 2021; 27 (5): 19–28. (In Russian)
21. Cain M. P., Rink R. C., Thomas A. C., et al. Symptomatic ureteropelvic junction obstruction in children in the era of prenatal sonography – is there a higher incidence of crossing vessels? Urology. 2001; 57: 338–41.
22. Chiarenza S. F., Bleve C., Fasoli L., Battaglino F., Bucci V., Novek S., Zolpi E. Ureteropelvic junction obstruction in children by polar vessels. Is laparoscopic vascular procedure a good solution? Single center experience on 35 consecutive patients. J Pediatr Surg. 2016; 51: 310–4.
23. Bombiński P., Brzewski M., Warchoł S., Gołębiowski M. One-phase split-bolus CT Urography – a novel approach to reduce radiation dose in diagnostics of congenital anomalies of kidneys and urinary tract in children. Dev Period Med. 2017; 21 (4): 402–7.
24. Wong M. C. Y., Piaggio G., Damasio M. B., Molinelli C., Ferretti S. M., Pistorio A., Ghiggeri G., Degl’Innocenti M. L., Canepa A., Incarbone V., Mattioli G. Hydronephrosis and crossing vessels in children: Optimization of diagnostic-therapeutic pathway and analysis of color Doppler ultrasound and magnetic resonance urography diagnostic accuracy. J Pediatr Urol. 2018; 14 (1): 68.e1–6.
25. Polok M., Borselle D., Toczewski K., Apoznański W., Patkowski D. Detection rate of crossing vessels in pediatric hydronephrosis: Transperitoneal laparoscopy versus open lumbotomy. Adv Clin Exp Med. 2019; 28 (11): 1507–11.
26. Schneider A., Gomes Ferreira C., Delay C., et al. Lower pole vessels in children with pelviureteric junction obstruction: laparoscopic vascular hitch or dismembered pyeloplasty? J Pediatr Urol. 2013; 9: 419–23.
27. Miranda M. L., Pereira L. H., Cavalaro M. A., et al. Laparoscopic transposition of lower pole crossing vessels (vascular hitch) in children with pelviureteric junction obstruction: how to be sure of the success of the procedure? J Laparoendosc Adv Surg Tech. 2015; 25: 847–51.
28. Szavay P., Heyne-Pietschmann M., Zundel S. M. Subpelvine Stenose / Kreuzendes Gefäß – kontra vascular hitch [Uretero-pelvic junction obstruction due to crossing pole vessel: contra vascular hitch]. Aktuelle Urol. 2020; 51: 121–6.
29. Kim J. K., Keefe D. T., Rickard M., Milford K., Lorenzo A. J., Chua M. E. Vascular hitch for paediatric pelvi-ureteric junction obstruction with crossing vessels: institutional analysis and systematic review with meta-analysis. BJU Int. 2022; 129 (6): 679–87. https://doi.org/10.1111/bju.15342
30. Al-Emadi I., Juricic M., Mouttalib S., Galinier P., Bouali O., Abbo O. Laparoscopic vascular hitch for polar vessels in pyeloureteric junction obstruction: medium-term follow-up of a monocentric experience. Eur J Pediatr Surg. 2021; 31 (3): 282–5.
31. Sizonov V. V., Shidaev A. H., Mayr J. M., Kogan M. I., Kagantsov I. M., Rostovskaya V. V. Transposition and fixation of lower pole crossing vessel in children with ureteropelvic junction obstruction: A STROBE-compliant study. Medicine (Baltimore). 2021; 100 (51): e28235. https://doi.org/10.1097/MD.0000000000028235
32. Villemagne T., Fourcade L., Camby C., Szwarc C., Lardy H., Leclair M. D. Long-term results with the laparoscopic transposition of renal lower pole crossing vessels. J Pediatr Urol. 2015; 11 (4): 174.e1–7.
