摘要
目的:总结机器人辅助腹腔镜治疗复杂肾积水的单中心早期经验.方法:系统性收集2023年1月至6月解放军总医院第三医学中心收治的20例复杂肾积水行机器人辅助腹腔镜手术患者的临床资料,并进行回顾性总结分析.复杂肾积水定义为通过单纯的Anderson-Hynes离断型肾盂成形术、输尿管端端吻合术或输尿管膀胱再植术无法解决的肾积水,梗阻原因包括肾盂成形术后再狭窄、内镜术后长段输尿管狭窄(>2 cm)、长段输尿管息肉(>2 cm)、肾盂输尿管连接部梗阻(UPJO)合并多发肾结石、UPJO合并马蹄肾等.手术成功定义为:症状消失或缓解且影像学检查提示肾积水较前缓解.结果:20例患者手术均在机器人辅助腹腔镜下完成,无术中并发症,无中转开放手术,其中机器人肾盂翻瓣输尿管成形术8例,机器人膀胱翻瓣输尿管成形术4例,机器人阑尾镶嵌输尿管成形术3例,机器人马蹄肾峡部离断+肾盂成形术2例,机器人舌黏膜镶嵌输尿管成形术、机器人结肠镶嵌输尿管成形术、机器人移植肾输尿管与自体输尿管端端吻合术各 1例.平均手术时间 222.5(185.8～313.0)min、术中中位失血量 50(50～100)ml、平均术后住院时间 5(4～5)d、平均术后引流管留置时间 3(2.0～3.8)d;术后并发症Clavien Ⅰ～Ⅱ 级发生率10%,即2例出现吻合口漏尿,给予延长引流管放置时间后自愈(分别放置 9 d和 10 d).中位随访5.2(3.0～8.5)个月,手术成功率为 95%(19/20).结论:机器人辅助腹腔镜手术治疗复杂肾积水安全可行,早期效果理想,根据不同梗阻原因(二次狭窄、输尿管长段狭窄)制定相关手术预案以及根据术中具体情况制定相关应对措施(翻瓣技术、组织替代技术)是提高手术成功率的关键.
Abstract
Objective:To report early single-center retrospective case series of outcomes after robot-assisted lap-aroscopic surgery in patients with complex hydronephrosis.Methods:The clinical data of 20 patients with complicat-ed hydronephrosis who underwent robotic-assisted laparoscopic surgery admitted to the Third Medical Center of PLA General Hospital from January 2023 to June 2023 were collected statistically and analyzed retrospectively.Complex hydronephrosis was defined as hydronephrosis that could not be resolved by Anderson-Hynes pyeloplasty,ureteroure-terostomy or ureteroneocystostomy.And the causes of obstruction included restenosis after pyeloplasty,long-seg-ment ureteral stenosis after endoscopic surgery(>2 cm),long-segment ureteral polyp(>2 cm),pyelo-ureteral junc-tion obstruction(UPJO)combined with multiple renal calculi,and UPJO combined with horseshoe kidney,etc.Sur-gical success was defined as the disappearance or relief of symptoms and imaging studies suggesting that the hydrone-phrosis was relieved compared with before.Results:All 20 patients were operated under robotic-assisted laparosco-py,with no intraoperative complication and no conversion to open surgery intraoperatively,including 8 cases of robot-ic dismembered pyeloplasty,4 cases of robotic Boari bladder flap ureteral reconstruction,3 cases of robotic appendi-ceal onlay ureteroplasty,2 cases of robotic dismembered for horseshoe kidney plus pyeloplasty,1 case of robotic lin-gual mucosal graft ureteroplasty,1 case of robotic colonic onlay ureteroplasty,and one case of robotic ureteroureter-ostomy between transplanted ureter and autologous ureter.The average operating time was 222.5(185.8-313.0)min,the median intraoperative blood loss was 50(50-100)ml,the average postoperative hospitalization was 5(4-5)d,and the average postoperative drain was left in place for 3(2.0-3.8)d.The incidence of postoperative Clavien's class Ⅰ-Ⅱ was 10％,and the anastomotic leakage was observed in 2 cases,which was resolved spontaneously after the exten-sion of drain placement(9 days and 2 days respectively).The median follow-up was 5.2(3.0-8.5)months,and the surgical success rate was 95％(19/20).Conclusion:Robotic-assisted laparoscopic surgery is safe and feasible for the treatment of complex hydronephrosis,with favorable early results.The development of surgical strategies according to the causes of obstruction(secondary stenosis,long ureteral stenosis)and the development of intraoperative coun-termeasures(flap technique,tissue replacement)are the keys to improve the success rate of the surgeries.
维普
万方数据