机器人辅助腹腔镜手术治疗复杂肾结石的可行性与安全性分析  

Feasibility and safety analysis of robot-assisted laparoscopic pyelolithotomy in the treatment of complicated renal calculi

作　　者：何威[1] 沈周俊[1] 徐兆平[1] 祝宇[1] 张荣明[1] 钟山[1] 王先进[1] 王晓晶[1] 

机构地区：[1]上海交通大学医学院附属瑞金医院泌尿外科,200025

出　　处：《中华泌尿外科杂志》2014年第1期36-39,共4页Chinese Journal of Urology

摘　　要：目的 探讨机器人辅助腹腔镜下肾盂切开取石术（robot-assisted laparoscopic pyelolithotomy,RALPL）治疗复杂肾结石的安全性和可行性. 方法 2013年3-7月,我科对4例复杂肾结石患者以达芬奇机器人辅助腹腔镜手术完成肾盂切开取石术.其中男3例,女1例.年龄37～59岁.2例因肾盂输尿管连接处梗阻（ureteropelvic junction obstruction,UPJO）合并结石而选择RALPL,另2例因肾结石合并同侧肾上腺肿瘤（原发性醛固酮增多症）而选择RALPL.结石位于左肾3例,右肾1例,均位于下盏或肾盂.结石直径27～33 mm.所有手术均采取经腹途径.UPJO合并结石患者在结石取出后行机器人辅助腹腔镜下肾盂成形术.肾结石合并同侧肾上腺肿瘤患者先在机器人辅助腹腔镜下切除同侧肾上腺肿瘤,再行RALPL. 结果 4例手术均获成功.2例合并UPJO者手术时间为90、120 min,失血量50、70 ml,术后住院时间4、5d.2例合并肾上腺腺瘤者手术时间110、130 min,失血量80、120 ml,术后住院时间5、7d.随访5～9个月,复查CT尿路造影均未发现残余结石. 结论 UPJO合并肾结石的患者是RALPL的可推荐适应证.对于其他复杂的肾结石,RALPL是一种可选的手术方式.Objective To discuss the feasibility and safety of robot-assisted laparoscopic pyelolithotomy （RALPL） for the treatment of complicated renal calculi.Methods Four cases of RALPL for complicated renal calculi were performed from March 2013 to July 2013.Of these cases,3 were male,and the other was female,whose age was 37-59 years.Two patients chose RALPL because they suffered from concomitant ureteropelvic junction obstruction （UPJO）,while the remaining 2 got ipsilateral adrenal tumor.All the stones located in lower calices or pelvis with 3 cases in left kidney and 1 in right.The calculus diameter was 27-33 mm.A transperitoneal approach was employed in all the cases.In patients with UPJO,robot-assisted laparoscopic pyeloplasty was conducted after RALPL was fulfilled.However,robot-assisted laparoscopic adrenalectomy was performed prior to RALPL for patients with ipsilateral adrenal tumor.Results The operations were accomplished successfully.The operating time,estimated blood loss and hospital stay in patients with UPJO was 90-120 min,50-70 ml,4-5 d,and 110-130 min,80-120 ml,5-7 d in patients with ipsilateral adrenal tumor.All the patients were followed up for 5-9 months and no evidence of residual fragment or hydronephrosis was identified in a repeat CT urography scan.Conclusions Renal calculi with concomitant UPJO is a recommendable indication for RALPL,which is also a selectable modality for other complicated renal calculi.

关 键 词：机器人 腹腔镜手术 肾结石 

分 类 号：R692.4[医药卫生—泌尿科学]