urovestВестник урологииUrology Herald2308-6424Rostov State Medical University10.21886/2308-6424-2020-8-1-92-98urovest-312Research ArticleКЛИНИЧЕСКИЕ НАБЛЮДЕНИЯCLINICAL CASESПервый опыт применения «миниатюрного» доступа для пиелопластики у детей«Miniature» Approach for Pyeloplasty in Children: Primary Use Experience Reporthttps://orcid.org/0000-0003-0742-7392АгзамходжаевС. Т.AgzamkhodjaevS. T.

Саиданвар Талатович Агзамходжаев – доктор философии; докторант кафедры факультетской детской хирургии

тел.: +9 (9897) 420-30-03

Saidanvar T. Agzamkhodjaev ‒ M.D., Ph.D. (M); Doctoral Candidate, Dept. of Pediatric Surgery

tel.: 9 (9897) 420-30-03

ast.doctor@gmail.comhttps://orcid.org/0000-0002-8410-6552АбдуллаевЗ. Б.AbdullaevZ. B.

Зафар Бобирович Абдуллаев ‒ ассистент кафедры факультетской детской хирургии

Zafar B. Abdullaev ‒ M.D.; Ass. Dept. of Pediatric Surgery

abdullaev.med@gmail.comhttps://orcid.org/0000-0002-0974-4482ЮнусовД. С.YunusovD. S.

Дилмурод Самихович Юнусов ‒ заведующий отделением урологии

Dilmurod S. Yunusov ‒ M.D.; Head, Urology Division

dilmuratuz@hotmail.comhttps://orcid.org/0000-0002-1400-178XТурсункуловА. Н.TursunkulovA. N.

Турсункулов Азимжон Назиржонович ‒ доктор философии; врач-эндоуролог в отделении урологии

Azimjon N. Tursunkulov ‒ M.D, Ph.D. (M); Endourologist, Urology Division

azimweb@gmail.comТашкентский педиатрический медицинский институтРоссияTashkent Pediatric Medical InstituteRussian FederationМногопрофильный медицинский центр «Akfa Medline»РоссияMultidisciplinary medical centre «Akfa Medline»Russian Federation202020042020819298Copyright © Агзамходжаев С.Т., Абдуллаев З.Б., Юнусов Д.С., Турсункулов А.Н., 20202020Агзамходжаев С.Т., Абдуллаев З.Б., Юнусов Д.С., Турсункулов А.Н.Agzamkhodjaev S.T., Abdullaev Z.B., Yunusov D.S., Tursunkulov A.N.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.urovest.ru/jour/article/view/312

В настоящее время лапароскопическая пиелопластика набирает популярность в детской урологии из-за минимальной инвазивности по сравнению с открытой стандартной пиелопластикой. Тем не менее, имеются основные «критические» замечания по поводу данной методики пиелопластики у детей, которые заключаются в возникновении некоторых трудностей при сопоставлении тканей и интракорпоральном наложении швов из-за ограниченного доступного пространства. Кроме того, существенным негативным моментом лапароскопической пиелопластики является длительность операции, особенно у младшей возрастной группы детей. Несмотря на все преимущества связанные с минимальной инвазивностью, существуют и альтернативные методики оперативного лечения, которые показывают достаточно впечатляющие результаты. Нами была впервые выполнена «миниатюрная» открытая пиелопластика у ребёнка с врождённым гидронефрозом с хорошим функциональным и косметическим результатом. Кроме того, данный доступ обеспечивает широкую экспозицию пиелоуретрального сегмента и лёгкую манипуляцию тканями.

Currently, laparoscopic pyeloplasty is gaining popularity in pediatric urology due to less invasive compared to the open standard pyeloplasty. Nevertheless, there are basic “critical” remarks about this pyeloplasty technique in children, which involve some difficulties in comparing tissues and intracorporeal suturing due to the limited available space. In addition, a significant negative point of laparoscopic pyeloplasty is the duration of the operation, especially in the younger age group of children. Despite all the advantages associated with minimal invasiveness, there are alternative methods of surgical treatment, which show quite impressive results. In our practical work, we performed minimally invasive open pyeloplasty: with a miniature incision, in a child with ureteropelvic junction obstruction with a good result. In addition, this access provides a wide exposure of the ureteropelvic junction and easy tissue manipulation.

врождённый гидронефрозобструкция пиелоуретерального сегментапиелопластикадетиcongenital hydronephrosisureteropelvic junction obstructionpyeloplastychildrenReferencesWeitz M, Schmidt M, Laube G. Primary non-surgical management of unilateral ureteropelvic junction obstruction in children: a systematic review. Pediatr Nephrol. 2017;32(12):2203‒2213. https://doi.org/10.1007/s00467-016-3566-3Weitz M, Schmidt M, Laube G. Primary non-surgical management of unilateral ureteropelvic junction obstruction in children: a systematic review. Pediatr Nephrol. 2017;32(12):2203‒2213. https://doi.org/10.1007/s00467-016-3566-3Krajewski W, Wojciechowska J, Dembowski J, Zdrojowy R, Szydełko T. Hydronephrosis in the course of ureteropelvic junction obstruction: An underestimated problem? Current opinions on the pathogenesis, diagnosis and treatment. Adv Clin Exp Med. 2017;26(5):857‒864. https://doi.org/10.17219/acem/59509Krajewski W, Wojciechowska J, Dembowski J, Zdrojowy R, Szydełko T. Hydronephrosis in the course of ureteropelvic junction obstruction: An underestimated problem? Current opinions on the pathogenesis, diagnosis and treatment. Adv Clin Exp Med. 2017;26(5):857‒864. https://doi.org/10.17219/acem/59509Oliveira EA, Oliveira MC, Mak RH. Evaluation and management of hydronephrosis in the neonate. Curr Opin Pediatr. 2016;28(2):195–201. https://doi.org/10.1097/MOP.0000000000000321Oliveira EA, Oliveira MC, Mak RH. Evaluation and management of hydronephrosis in the neonate. Curr Opin Pediatr. 2016;28(2):195–201. https://doi.org/10.1097/MOP.0000000000000321Klingler HC, Remzi M, Janetschek G, Kratzik C, Marberger MJ. Comparison of open versus laparoscopic pyeloplasty techniques in treatment of uretero-pelvic junction obstruction. Eur. Urol. 2003;44(3):340‒345. https://doi.org/10.1016/s0302-2838(03)00297-5Klingler HC, Remzi M, Janetschek G, Kratzik C, Marberger MJ. Comparison of open versus laparoscopic pyeloplasty techniques in treatment of uretero-pelvic junction obstruction. Eur. Urol. 2003;44(3):340‒345. https://doi.org/10.1016/s0302-2838(03)00297-5Yanke BV, Lallas CD, Pagnani C, McGinnis DE, Bagley DH. The minimally invasive treatment of ureteropelvic junction obstruction: a review of our experience during the last decade. J Urol. 2008;180(4):1397. https://doi.org/10.1016/j.juro.2008.06.020Yanke BV, Lallas CD, Pagnani C, McGinnis DE, Bagley DH. The minimally invasive treatment of ureteropelvic junction obstruction: a review of our experience during the last decade. J Urol. 2008;180(4):1397. https://doi.org/10.1016/j.juro.2008.06.020Singh V, Garg M, Sharma P, Sinha RJ, Kumar M. Mini incision open pyeloplasty - Improvement in patient outcome. Int Braz J Urol. 2015;41(5):927‒934. https://doi.org/10.1590/S1677-5538.IBJU.2014.0024Singh V, Garg M, Sharma P, Sinha RJ, Kumar M. Mini incision open pyeloplasty - Improvement in patient outcome. Int Braz J Urol. 2015;41(5):927‒934. https://doi.org/10.1590/S1677-5538.IBJU.2014.0024Ruiz E, Soria R, Ormaechea E, Marcelo M, Lino U, Moldes JM, Ignacio de Badiola F. Simplified Open Approach to Surgical Treatment of Ureteropelvic Junction Obstruction in Young Children and Infants. J Urol. 2011;185(6):2512‒2516. https://doi.org/10.1016/j.juro.2011.01.012Ruiz E, Soria R, Ormaechea E, Marcelo M, Lino U, Moldes JM, Ignacio de Badiola F. Simplified Open Approach to Surgical Treatment of Ureteropelvic Junction Obstruction in Young Children and Infants. J Urol. 2011;185(6):2512‒2516. https://doi.org/10.1016/j.juro.2011.01.012Kajbafzadeh AM, Tourchi A, Nezami BG, Khakpour M, Mousavian AA, Talab SSh. Miniature pyeloplasty as a minimally invasive surgery with less than 1-day admission in infants. JPediatrUrol. 2011;7(3):283‒288. https://doi.org/10.1016/j.jpurol.2011.02.030Kajbafzadeh AM, Tourchi A, Nezami BG, Khakpour M, Mousavian AA, Talab SSh. Miniature pyeloplasty as a minimally invasive surgery with less than 1-day admission in infants. JPediatrUrol. 2011;7(3):283‒288. https://doi.org/10.1016/j.jpurol.2011.02.030O’nol FF, Akbas A, Kose O, Onol SY. Short stay pyeloplasty with transverse dorsal lumbotomy incision: our 10-year experience. Urology. 2009;74(6):1309. https://doi.org/10.1016/j.urology.2009.06.090O’nol FF, Akbas A, Kose O, Onol SY. Short stay pyeloplasty with transverse dorsal lumbotomy incision: our 10-year experience. Urology. 2009;74(6):1309. https://doi.org/10.1016/j.urology.2009.06.090Nguyen HT, Herndon CD, Cooper C, Gatti J, Kirsch A, Kokorowski P, Lee R, Perez-Brayfield M, Metcalfe P, Yerkes E, Cendron M, Campbell JB. The Society for Fetal Urology consensus statement on the evaluation and management of antenatal hydronephrosis. J Ped. Urol. 2010;6(3):212‒231. https://doi.org/10.1016/j.jpurol.2010.02.205Nguyen HT, Herndon CD, Cooper C, Gatti J, Kirsch A, Kokorowski P, Lee R, Perez-Brayfield M, Metcalfe P, Yerkes E, Cendron M, Campbell JB. The Society for Fetal Urology consensus statement on the evaluation and management of antenatal hydronephrosis. J Ped. Urol. 2010;6(3):212‒231. https://doi.org/10.1016/j.jpurol.2010.02.205Kavoussi LR, Peters CA. Laparoscopic pyeloplasty. J Urol. 1993;150(6):1891‒1894. https://doi.org/10.1016/S0022-5347(17)35926-8Kavoussi LR, Peters CA. Laparoscopic pyeloplasty. J Urol. 1993;150(6):1891‒1894. https://doi.org/10.1016/S0022-5347(17)35926-8Schuessler WW, Grune MT, Tecuanhuey LV, Preminger GM. Laparoscopic dismembered pyeloplasty. J Urol. 1993;150(6):1795–1799. https://doi.org/10.1016/S0022-5347(17)35898-6Schuessler WW, Grune MT, Tecuanhuey LV, Preminger GM. Laparoscopic dismembered pyeloplasty. J Urol. 1993;150(6):1795–1799. https://doi.org/10.1016/S0022-5347(17)35898-6Yeung CK, Tam YH, Sihoe JD, Lee KH, Liu KW. Retroperitoneoscopic dismembered pyeloplasty for pelviureteric junction obstruction in infants and children. BJU Int. 2001;87(6):509–513. https://doi.org/10.1046/j.1464-410x.2001.00129.xYeung CK, Tam YH, Sihoe JD, Lee KH, Liu KW. Retroperitoneoscopic dismembered pyeloplasty for pelviureteric junction obstruction in infants and children. BJU Int. 2001;87(6):509–513. https://doi.org/10.1046/j.1464-410x.2001.00129.xКаганцов И.М., Минин А.Е., Санников И.А. Лапароскопическая пиелопластика — современный стандарт лечения врождённого гидронефроза у детей. Российский вестник детской хирургии, анестезиологии и реанимации. 2012;2(2):15‒20. eLIBRARY ID: 17847985Kagantsov I.M., Minin A.E., Sannikov I.A. Laparoscopic pyeloplasty is the modern standard in the treatment of congenital hydronephrosis in children. Russian Bulletin of Pediatric Surgery, Anesthesiology and Intensive Care. 2012;2(2): 15‒20. (In Russ.). eLIBRARY ID: 17847985Врублевский С.Г., Гуревич А.И., Врублевская Е.Н., Аль-Машат Н.А., Шмыров О.С., Захаров А.И., Склярова Т.А., Королева О.В., Ефимова В.И. Эндохирургическая пиелопластика у детей как эволюция «золотого стандарта». Детская хирургия. 2013;(6):4‒6. eLIBRARY ID: 21178610Vrublevsky S.G., Gurevich A.I., Vrublevskaya E.N., Al-Mashat N.A., Shmyrov O.S., Zakharov A.I., Sklyarova T.A., Koroleva O.B., Efimova V.I. Endosurgical pyeloplasty in children as evolution of the «golden standard». Children’s surgery. 2013;(6):4‒6. (In Russ.). eLIBRARY ID: 21178610Бондаренко С.Г., Абрамов Г.Г. Лапароскопическая пиелопластика у детей грудного возраста. Детская хиургия. 2013;(6):7‒10. eLIBRARY ID: 21178611Bondarenko S.G., Abramov G.G. Laparoscopic pyeloplasty in infants. Children’s Hyurgia. 2013;(6):7‒10. (In Russ.). eLIBRARY ID: 21178611Janetschek G., Peschel R., Altarac S, Bartsch G. Laparoscopic and retroperitoneoscopic repair of ureteropelvic junction obstruction. Urology. 1996;47(3):311‒316. https://doi.org/10.1016/S0090-4295(99)80444-0Janetschek G., Peschel R., Altarac S, Bartsch G. Laparoscopic and retroperitoneoscopic repair of ureteropelvic junction obstruction. Urology. 1996;47(3):311‒316. https://doi.org/10.1016/S0090-4295(99)80444-0Cascio S, Tien A, Chee W, Tan HL. Laparoscopic Dismembered Pyeloplasty in Children Younger Than 2 Years. J Urol. 2007;177(1):335‒338. https://doi.org/10.1016/j.juro.2006.08.145Cascio S, Tien A, Chee W, Tan HL. Laparoscopic Dismembered Pyeloplasty in Children Younger Than 2 Years. J Urol. 2007;177(1):335‒338. https://doi.org/10.1016/j.juro.2006.08.145Jarrett TW, Chan DY, Charambura TC, Fugita O, Kavoussi, LR. Laparoscopic pyeloplasty: the first 100 cases. J Urol. 2002;167(3):1253‒1256. https://doi.org/10.1016/S0022-5347(05)65276-7Jarrett TW, Chan DY, Charambura TC, Fugita O, Kavoussi, LR. Laparoscopic pyeloplasty: the first 100 cases. J Urol. 2002;167(3):1253‒1256. https://doi.org/10.1016/S0022-5347(05)65276-7Job K, Chacko AB, Martin A, Koyle AB, Gerald C, Mingin AB, Peter D. The minimally invasive open pyeloplasty. J Urol. 2006;2(4):368‒372. https://doi.org/10.1016/j.jpurol.2006.05.001Job K, Chacko AB, Martin A, Koyle AB, Gerald C, Mingin AB, Peter D. The minimally invasive open pyeloplasty. J Urol. 2006;2(4):368‒372. https://doi.org/10.1016/j.jpurol.2006.05.001

The authors declare that there are no conflicts of interest present.