机器人辅助腹腔镜和腹腔镜肾盂瓣输尿管成形术在输尿管上段长段狭窄中的应用
Application of robot-assisted laparoscopic pyeloplasty in the treatment of long-segment upper ureteral stricture
孙逸 1程功 1刘岳南 1周袁成 1董伟 1刘磊 1孙加印 1杨雄 1石瑛 1鞠文 1赵军 1肖亚军 1陈敏 1章小平 1韩晓敏1
作者信息
- 1. 华中科技大学同济医学院附属协和医院泌尿外科(武汉,430022)
- 折叠
摘要
目的:分析并总结肾盂瓣输尿管重建手术在输尿管上段长段狭窄中的应用经验及疗效.方法:回顾性分析2022年1月-2023年12月在华中科技大学同济医学院附属协和医院泌尿外科住院治疗的26例输尿管上段长段狭窄患者的临床资料,其中先天性肾盂输尿管连接部梗阻16例,包含肾盂输尿管成形术后再狭窄5例;输尿管镜钬激光碎石术后输尿管上段狭窄10例.术前检查提示狭窄段3～7 cm,术中采用肾盂瓣完成肾盂输尿管连接部的重建,其中腹腔镜手术6例(腹腔镜组),机器人辅助腹腔镜手术20例(机器人组).分析2组患者的手术时间、平均出血量、平均住院日、术后肾盂前后径变化及症状改善情况.结果:所有患者均在腹腔镜或机器人辅助腹腔镜下完成,均未中转开放手术.腹腔镜组肾盂瓣输尿管成形术的平均手术时间为(131±46)min,术中平均出血量(103±66)mL,术后平均住院日(7±5)d,术后肾盂前后径缩小达95.33％,术后腹痛或腰部胀痛情况均有缓解.机器人组肾盂瓣输尿管成形术的平均手术时间为(127±24)min,术中平均出血量(48±24)mL,术后平均住院日(5.7±1.2)d,术后肾盂前后径缩小达97.00％,术后腹痛或腰部胀痛情况均有缓解.结论:肾盂瓣输尿管成形术在输尿管上段长段狭窄中取得了较好的治疗效果,操作较易掌握,且机器人辅助腹腔镜手术较腹腔镜手术具有更好的临床效果.但目前所报道的多为单一中心小样本研究,仍需更大样本量、前瞻性的研究及长期随访以进一步评估其临床有效性.
Abstract
Objective:To analyze and summarize the clinical experience and therapeutic effects of renal pelvis flap ureteral reconstruction surgery in long-segment upper ureteral stricture.Methods:Clinical data of 26 patients undergoing renal pelvis flap ureteroplasty in the Department of Urology of Union Hospital affiliated to Tongji Medical College of Huazhong University of Science and Technology from January 2022 to December 2023 were an-alysed retrospectively,including 16 cases of congenital ureteropelvic junction obstruction(5 cases of re-stricture after ureteroplasty),and 10 cases of upper ureteral stricture after ureteroscopic holmium lithotripsy.Urinary ima-ging examinations were performed in all patients,and the results showed that the stricture length of the upper ure-ter was between 3-7 cm.Among all 26 patients,renal pelvis flaps were used for reconstructions of the uretero-pelvic junction during surgery,which includes 6 cases of laparoscopic surgery,and 20 cases of da Vinci robot-as-sisted laparoscopic surgery.Then the operation time,average bleeding volume,average postoperative hospitaliza-tion time,postoperative anteroposterior diameter alterations of renal pelvis,and clinical symptom improvement of patients were analyzed.Results:All cases were completed by laparoscopy or robot-assisted laparoscopy,and there was no conversion to open surgery.Among 6 cases of laparoscopic pelvic flap ureteroplasty,the average operation time was(131±46)minutes,the average intraoperative blood loss was(103±66)mL,the average postoperative hospitalization time was(7±5)days,postoperative anteroposterior diameter reduction rate of renal pelvis was 95.33％,and abdominal pain or lower back pain were all relieved after surgeries.While among 20 cases of robot-assisted laparoscopic pelvic flap ureteroplasty,the average operation time was(127±24)minutes,the average in-traoperative blood loss was(48±24)mL,the average postoperative hospitalization time was(5.7±1.2)days,postoperative anteroposterior diameter reduction rate of renal pelvis was 97.00％.Symptoms such as abdominal pain or lower back pain were all relieved after surgeries.Conclusion:Renal pelvic flap ureteroplasty has achieved good therapeutic effects in the treatment of long-segment upper ureteral stricture,and the operation is well con-trolled and conducted.Moreover,robot-assisted laparoscopic surgery has clinical significance and promising pros-pects compared to laparoscopic surgery.However,currently most reported studies were conducted in single center with small sample size,therefore,prospective studies with larger sample size and long-term follow-up data are still needed to further evaluate its clinical efficacy.
关键词
肾积水/输尿管上段长段狭窄/肾盂瓣输尿管成形术/腹腔镜/达芬奇机器人Key words
hydronephrosis/long-segment upper ureteral stricture/renal pelvis flap ureteroplasty/laparosco-py/da Vinci robot引用本文复制引用
出版年
2024
NETL
NSTL
万方数据