机器人辅助腹腔镜上尿路修复手术:单一术者108例经验总结  

Robot-assisted laparoscopic upper urinary tract reconstruction surgery:A review of 108 cases by a single surgeon

作　　者：程嗣达 李新飞 熊盛炜 樊书菠 王杰 朱伟杰 李子奡 丁光璞 俞婷[2] 李万强[3] 孙永明[4] 杨昆霖 张雷[1] 郝瀚[1] 李学松[1] 周利群[1] CHENG Si-da;LI Xin-fei;XIONG Sheng-wei;FAN Shu-bo;WANG Jie;ZHU Wei-jie;LI Zi-ao;DING Guang-pu;YU Ting;LI Wan-qiang;SUN Yong-ming;YANG Kun-lin;ZHANG Lei;HAO Han;LI Xue-song;ZHOU Li-qun(Department of Urology,Peking University First Hospital,Institute of Urology,Peking University,National Urological Cancer Center,Beijing 100034,China;Department of Urology,The Second Hospital of Sanming,Sanming 366000,Fujian,China;Department of Urology,The First College of Clinical Medical Science,Three Gorges University/Yichang Central People’s Hospital,Yichang 443003,Hubei,China;Department of Urology,Suqian People’s Hospital of Nanjing Drum Tower Hospital Group,Suqian 223800,Jiangsu,China)

机构地区：[1]北京大学第一医院泌尿外科,北京大学泌尿外科研究所,国家泌尿、男性生殖系肿瘤研究中心,北京100034 [2]三明市第二医院泌尿外科,福建三明366000 [3]三峡大学第一临床医学院/宜昌市中心人民医院泌尿外科,湖北宜昌443003 [4]南京鼓楼医院集团宿迁市人民医院泌尿外科,江苏宿迁223800

出　　处：《北京大学学报（医学版）》2020年第4期771-779,共9页Journal of Peking University:Health Sciences

摘　　要：目的:总结分析单一术者机器人辅助腹腔镜上尿路修复手术的技术经验及治疗效果。方法:回顾性分析2018年11月至2020年1月由单一术者完成的108例机器人辅助腹腔镜上尿路修复手术的临床资料,包括改良后离断肾盂成形术53例、肾盂瓣成形术11例、输尿管狭窄段切除再吻合术11例、输尿管狭窄切开自体舌黏膜修补术5例、输尿管狭窄切开阑尾补片修复术4例、输尿管膀胱再植术11例、术中精确测量法膀胱悬吊翻瓣术6例和改良回肠代输尿管术7例。手术成功定义为主观症状缓解且泌尿系超声提示肾积水缓解。结果:108例手术均成功完成,无中转普通腹腔镜及开放手术。改良后离断肾盂成形术,中位手术时间141 min(74~368 min),中位出血量20 mL(10~350 mL),中位术后住院时间4 d(3~19 d),手术成功率为94.3%。肾盂瓣成形术,中位手术时间159 min(110~222 min),中位出血量50 mL(20~150 mL),中位术后住院时间5 d(3~8 d),手术成功率为100%。输尿管狭窄段切除再吻合术,中位手术时间126 min(76~160 min),中位术中出血量20 mL(10~50 mL),中位术后住院时间5 d(4~9 d),手术成功率为100%。输尿管狭窄切开自体舌黏膜补片修补术,中位手术时间204 min(154~250 min),中位出血量30 mL(10~100 mL),中位术后住院时间6 d(4~7 d),手术成功率为100%。输尿管狭窄切开阑尾补片修复术,中位手术时间164 min(135~211 min),中位手术出血量75 mL(50~200 mL),中位术后住院日8.5 d(6~12 d),手术成功率为100%。输尿管膀胱再植术,中位手术时间149 min(100~218 min),中位术中出血量20 mL(10~50 mL),中位术后住院日7 d(5~10 d),手术成功率为90.9%。术中精确测量法膀胱悬吊翻瓣术,中位手术时间166 min(137~205 min),中位手术出血45 mL(20~100 mL),中位术后住院时间5 d(4~41 d),手术成功率为83.3%。改良回肠代输尿管手术,中位手术时间270 min(227~335 min),中位术中出血量100 mL(10~100 mL),中位术后住�Objective:To summarize the experiences and outcomes of 108 robot-assisted laparoscopic upper urinary tract reconstruction surgeries conducted by a single surgeon.Methods:We consecutively and retrospectively reviewed 108 patients who underwent robot-assisted laparoscopic upper urinary tract reconstruction surgeries by a single surgeon from November 2018 to January 2020.The patient demographics,perioperative variables,postoperative complications and follow-up data were recorded.Fifty-three modified dismembered pyeloplasties(MDP),11 spiral flap pyeloplasties(SFP),11 ure-teroureterostomies(UUT),4 lingual mucosal onlay graft ureteroplasties(LMU),5 appendiceal onlay flap ureteroplasties(AU),11 ureteral reimplantations(UR),6 Boari flap-Psoas hitch surgeries(BPS)and 7 ileal ureter replacements(IUR)were enrolled finally.The success was defined as the improvement in subjective pain levels,and the improvement in the degree of hydronephrosis at ultrasound.Results:All the surgeries were successfully completed without open or laparoscopic conversion.The median operative time was 141 min(range:74-368 min),median blood loss was 20 mL(range:10-350 mL)and median hospital stay was 4 d(range:3-19 d)in MDP group,with the success rate of 94.3%.The median operative time was 159 min(range:110-222 min),median blood loss was 50 mL(range:20-150 mL)and median hospital stay was 5 d(range:3-8 d)in SFP group,with the success rate of 100%.The median operative time was 126 min(range:76-160 d),median blood loss was 20 mL(range:10-50 mL)and median hospital stay was 5 d(range:4-9 d)in UUT group,with the success rate of 100%.The median operative time was 204 min(range:154-250 min),median blood loss was 30 mL(range:10-100 mL)and median hospital stay was 6 d(range:4-7 d)in LMU group,with the success rate of 100%.The median operative time was 164 min(range:135-211 min),median blood loss was 75 mL(range:50-200 mL)and median hospital stay was 8.5 d(range:6-12 d)in AU group,with the success rate of 100%.The median operative time was 149 min(range:100-218

关 键 词：机器人手术 腹腔镜 上尿路 修复外科手术 

分 类 号：R693.2[医药卫生—泌尿科学]