机器人辅助腹腔镜Lich-Gregoir输尿管再植术与气膀胱Cohen输尿管再植术治疗原发性膀胱输尿管反流的疗效对比  

Comparison of clinical efficacy of robot-assisted laparoscopic Lich-Gregoir procedure and gas-bladder laparoscopic Cohen ureteral reimplantation for primary vesicoureteral reflux

作　　者：朱炜玮 周辉霞 李品 赵扬 郭涛 韩策 卓然 吕雪雪 陶元东 马立飞 陶天 周晓光 Zhu Weiwei;Zhou huixia;Li Pin;Zhao Yang;Guo Tao;Han Ce;Zhuo Ran;Lyu Xuexue;Tao Yuandong;Ma Lifei;Tao Tian;Zhou Xiaoguang(Medical School of Chinese PLA,Beijing 100853,China;Department of Pediatrics,Seventh Medical Center,General Hospital of PLA,Beijing 100700,China)

机构地区：[1]解放军医学院,北京100853 [2]中国人民解放军总医院第七医学中心儿科医学部,北京100700

出　　处：《临床小儿外科杂志》2022年第5期437-444,共8页Journal of Clinical Pediatric Surgery

基　　金：首都临床特色应用研究(Z181100001718008);军队计生课题(18JS001);首都卫生发展科研专项(2016-2-5091);卫生部行业科研专项(201402007)。

摘　　要：目的初步评价机器人辅助腹腔镜Lich-Gregoir输尿管再植术与气膀胱Cohen输尿管再植术治疗儿童原发性膀胱输尿管反流(vesicoureteral reflux,VUR)的临床疗效。方法将2016年1月至2020年8月解放军总医院第七医学中心儿科医学部行手术治疗的87例VUR患儿纳入研究,按照单侧或双侧VUR将患儿分为单侧组及双侧组,单侧组和双侧组又根据手术方式进一步分为单侧机器人组(25例)、双侧机器人组(22例)、单侧气膀胱组(22例)和双侧气膀胱组(18例)。单侧机器人组和双侧机器人组统称为机器人组,实施机器人辅助腹腔镜Lich-Gregoir输尿管再植术;单侧气膀胱组和双侧气膀胱组统称为气膀胱组,实施气膀胱Cohen输尿管再植术。分别比较单侧组和双侧组中机器人组、气膀胱组的术前准备时间、腹腔内手术操作时间、术中出血量、术后留置尿管天数及术后住院天数。记录各组患儿术后随访情况。结果所有患儿均顺利完成手术,无一例中转开放手术。在单侧VUR患儿中,机器人组和气膀胱组的术前准备时间分别为(15.3±2.9)min和(28.8±4.0)min;腹腔内手术操作时间分别为(34.9±3.0)min和(46.7±8.9)min;留置尿管天数分别为4(3,4)d和4(3,5)d;术中失血量分别为(14.7±2.7)mL和(16.8±2.8)mL;术后住院天数分别为(8.8±2.1)d和(10.5±2.8)d。在双侧VUR患儿中,机器人组和气膀胱组的术前准备时间分别为(16.5±3.6)min和(20.0±2.9)min;腹腔内手术操作时间分别为(81.6±8.1)min和(95.9±7.9)min;留置尿管天数分别为4(3,5)d和4(3,5)d;术中失血量分别为(36.4±7.0)mL和(34.4±6.0)mL;术后住院天数分别为7.5(7,9)d和9(7.8,10)d。按照手术方式进行比较,机器人组与气膀胱组患儿术前准备时间[单侧机器人组比单侧气膀胱组为(15.3±2.9)min比(28.8±4.9)min;双侧机器人组比双侧气膀胱组为(16.5±3.6)min比(20.0±2.9)min]、腹腔内手术操作时间[单侧机器人组比单侧气膀胱组为(34.9±3.0Objective To compare the clinical efficacy of robot-assisted laparoscopic procedure versus gas-bladder laparoscopic Cohen ureteral reimplantation for vesicoureteral reflux.Methods From June 2016 to June 2020,87 children of primary vesicoureteral reflux(VUR)were recruited.According to the presence of bilateral/unilateral VUR,they were divided into unilateral and bilateral groups.And bilateral/unilateral VUR groups were further assigned into two groups of unilateral/bilateral robotic(n=25;n=22)and unilateral/bilateral gas-bladder laparoscopic Cohen ureteral reimplantation(n=22;n=18).The relevant clinical data were analyzed,including preoperative preparation time,intraperitoneal operative duration,intraoperative blood loss,length of ureteral catheterization and postoperative hospital stay.Postoperative follow-ups were conducted.Results All operations were successful without any conversion.In unilateral VUR children,preoperative preparation time of robotic and gas-bladder groups was(15.3±2.9)vs.(28.8±4.0)min,intraperitoneal operative duration(34.9±3.0)vs.(46.7±8.9)min,length of ureteral catheterization 4(3,4)vs.4(3,5)days,intraoperative blood loss(14.7±2.7)vs.(16.8±2.8)ml and postoperative hospital stay(8.8±2.1)vs.(10.5±2.8)days respectively.In bilateral VUR children,preoperative preparation time of robotic and gas-bladder groups was(16.5±3.6)vs.(20.0±2.9)min,intraperitoneal operative duration(81.6±8.1)vs.(95.9±7.9)min,length of ureteral catheterization 4(3,5)vs.4(3,5)days,intraoperative blood loss(36.4±7.0)vs.(34.4±6.0)ml and postoperative hospital stay 7.5(7,9)vs.9(7.8,10)days respectively.Among unilateral/bilateral children,preoperative preparation time,intraperitoneal operative duration and postoperative hospital stay showed significant statistical differences between robotic and gas-bladder groups.No statistical differences in intraoperative blood loss or length of ureteral catheterization existed between robotic and gas-bladder groups.There was no high-grade postoperative complication.Conclusion B

关 键 词：原发性膀胱输尿管反流 机器人手术 腹腔镜辅助外科手术 治疗结果 对比研究 

分 类 号：R726.9[医药卫生—儿科]