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| 挽救性机器人辅助腹腔镜肾盂成形术治疗复发性肾盂输尿管连接部梗阻 |
| 杨罗佳,张鹏,彭程,杨阳,贾通宇,黄庆波,王保军,马鑫*,张旭 |
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(解放军总医院第一医学中心泌尿外科, 北京 100853
*通信作者) |
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| 摘要: |
| 目的 探讨挽救性机器人辅助腹腔镜肾盂成形术治疗复发性肾盂输尿管连接部梗阻（UPJO）的临床效果并总结手术经验。方法 2015年8月至2018年7月，27例复发性UPJO患者在解放军总医院第一医学中心泌尿外科接受挽救性机器人辅助腹腔镜肾盂成形术治疗。其中男20例，女7例；年龄12~63岁，中位年龄31岁；一次肾盂成形术手术史26例，二次肾盂成形术手术史1例。记录围手术期情况。术后定期复查超声及尿常规，必要时行计算机断层扫描泌尿系造影或发射计算机断层显像检查。结果 所有手术均顺利完成，无术中转开放手术者。手术时间为105~360 min，平均（159.7±54.2）min；术中出血量为10~100 mL，平均（36.3±20.2）mL；术后导尿管留置时间为2~10 d，平均（4.2±2.4）d；引流管留置时间为3~7 d，平均（4.7±1.8）d；术后住院时间为3~12 d，平均（4.4±2.9）d。术后8周取出双J管。术后随访12~36个月，平均（21.2±9.8）个月。26例肾积水明显改善或消失，肾功能得到不同程度恢复，达到手术治愈标准；1例肾实质变薄，梗阻未见减轻，输尿管镜检查可见吻合口出现狭窄环，再置入双J管2个月取出后缓解。结论 挽救性机器人辅助腹腔镜肾盂成形术对于复发性UPJO是一种安全、成功率高的手术方式，术后并发症发生率低，改善肾积水和肾功能效果满意。在设备与技术条件允许的情况下，推荐机器人辅助腹腔镜肾盂成形术作为复发性UPJO患者的优选治疗方式。 |
| 关键词: 肾盂输尿管连接部梗阻 肾盂成形术 机器人手术 腹腔镜技术 挽救性手术 |
| DOI：10.16781/j.0258-879x.2020.07.0725 |
| 投稿时间：2019-08-07修订日期：2020-04-20 |
| 基金项目: |
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| Salvage robot-assisted laparoscopic pyeloplasty for recurrent ureteropelvic junction obstruction |
| YANG Luo-jia,ZHANG Peng,PENG Cheng,YANG Yang,JIA Tong-yu,HUANG Qing-bo,WANG Bao-jun,MA Xin*,ZHANG Xu |
(Department of Urology, The First Medical Center of PLA General Hospital, Beijing 100853, China
*Corresponding author) |
| Abstract: |
| Objective To evaluate the clinical efficacy of salvage robot-assisted laparoscopic pyeloplasty for recurrent ureteropelvic junction obstruction (UPJO) and summarize the surgical experience. Methods From Aug. 2015 to Jul. 2018, 27 patients with recurrent UPJO received salvage robot-assisted laparoscopic pyeloplasty in the Department of Urology, the First Medical Center of PLA General Hospital. There were 20 males and 7 females with a median age of 31 years (range, 12-63 years). Among them, 26 patients failed in the primary pyeloplasty and one patient had a history of secondary pyeloplasty. The perioperative data were recorded. Ultrasound and urine routine examination were done postoperatively during follow-up, and computed tomography urography or emission computed tomography was performed when necessary. Results All operations were successfully completed without converting to open surgery. The operation time was 105-360 min (mean [159.7±54.2] min), estimated blood loss was 10-100 mL (mean [36.3±20.2] mL), the time of catheter indwelling was 2-10 d (mean [4.2±2.4] d), the time of drainage tube indwelling was 3-7 d (mean [4.7±1.8] d), and the postoperative hospitalization time was 3-12 d (mean [4.4±2.9] d). Double-J ureteral catheters were removed 8 weeks postoperatively. The follow-up time was 12-36 months (mean [21.2±9.8] months). The hydronephrosis was relieved or disappeared in 26 cases and renal function was recovered to varying degrees, which reached the criterion of surgical cure. The thickness of renal parenchyma decreased in one case without any relief of obstruction, and ureteroscopy showed a narrow ring at the anastomotic site, which was relieved after the double-J ureteral catheter was placed, and the catheter was finally removed after 2 months. Conclusion Salvage robot-assisted laparoscopic pyeloplasty is a safe and feasible procedure for recurrent UPJO, with low incidence of complications and satisfactory results in ameliorating hydronephrosis and renal function. Robot-assisted laparoscopic pyeloplasty is recommended for recurrent UPJO when the corresponding facility and technique are available. |
| Key words: ureteropelvic junction obstruction pyeloplasty robotic surgical procedures laparoscopy salvage surgery |
