机器人辅助腹腔镜改良非乳头Lich-Gregoir输尿管膀胱再植术治疗梗阻型巨输尿管  

Modified Robot-assisted Laparoscopic Non-papillary Lich-Gregoir Extravesical Reimplantation for Primary Obstructive Megaureter

作　　者：林珊[1] 何玉锋 陈江龙 汤坤彬 徐新茹 徐迪[1] Lin Shan;He Yufeng;Chen Jianglong(Department of Pediatric Surgery,Fujian Provincial Hospital,Provincial Clinical Medical College of Fujian Medical University,Fuzhou 350001,China)

机构地区：[1]福建省立医院小儿外科、福建医科大学省立临床医学院,福州350001

出　　处：《中国微创外科杂志》2023年第2期129-134,共6页Chinese Journal of Minimally Invasive Surgery

基　　金：福建省卫生健康科技项目医学创新课题(2020CXB004)。

摘　　要：目的探讨机器人辅助腹腔镜改良非乳头Lich-Gregoir输尿管膀胱再植术治疗原发性梗阻型巨输尿管(primary obstructive megaureter,POM)的效果。方法回顾性分析2021年2~12月12例POM的临床资料。年龄8~60(34.2±24.9)月。梗阻型9例,梗阻伴反流型3例。使用da Vinci Xi机器人手术系统,通过斜行逼尿肌隧道联合输尿管非乳头植入方式行改良Lich-Gregoir输尿管膀胱再植术。比较手术前和术后12个月各项参数变化。结果手术时间140~170(152.8±10.5)min,手术出血量<5 ml,术后住院时间3~4 d。随访时间12~18(13.7±2.2)月。术后12个月复查,输尿管最大直径、最大肾盏直径、肾盂前后径较术前明显缩小[(18.0±3.2)mm vs.(5.8±1.1)mm,(14.0±3.6)mm vs.(3.5±2.9)mm,(32.5±3.3)mm vs.(7.8±1.6)mm,均P=0.000],肾皮质厚度和分肾功能较术前增加[(3.6±1.7)mm vs.(5.8±1.9)mm,(33.1±2.2)%vs.(40.6±4.1)%,均P=0.000],利尿肾图梗阻曲线类型改善(P=0.000),均无膀胱输尿管反流。结论机器人辅助腹腔镜改良非乳头Lich-Gregoir输尿管膀胱再植术,利用非乳头植入和符合输尿管走行的斜行逼尿肌隧道双重抗反流机制,简化手术流程,安全有效,是机器人手术治疗小儿POM的可选术式。Objective To investigate the effect of modified robot-assisted laparoscopic non-papillary Lich-Gregoir extravesical reimplantation in the treatment of primary obstructive megaureter(POM).Methods Clinical data of 12 children with POM admitted from February 2021 to December 2021 were retrospectively analyzed.The age was 8-60(34.2±24.9)months old.There were 9 cases of obstruction type and 3 cases of obstruction with reflux type.By using the da Vinci Xi robotic system,we implemented the method of oblique detrusor tunnel and non-papillary Lich-Gregoir ureter reimplantation to complete the surgery.The changes of parameters before and 12 months after surgery were compared.Results The operation time was 140-170(152.8±10.5)min,the operative blood loss was less than 5 ml,and the postoperative hospital stay was 3-4 d.The follow-up time was 12-18(13.7±2.2)months.The re-examination at 12 months after operation showed that the largest diameter of the ureter,the largest diameter of the renal calyx,and the anterior and posterior diameters of the renal pelvis were significantly reduced[(18.0±3.2)mm vs.(5.8±1.1)mm,(14.0±3.6)mm vs.(3.5±2.9)mm,(32.5±3.3)mm vs.(7.8±1.6)mm,all P=0.000].The renal cortical thickness and renal function were significantly increased[(3.6±1.7)mm vs.(5.8±1.9)mm,(33.1±2.2)%vs.(40.6±4.1)%,all P=0.000],and the type of obstruction curve was improved(P=0.000).The voiding cystourethrography re-examination at 12 months after operation showed that none of the 12 children had vesicoureteral reflux.Conclusions In order to enhance the anti-reflux mechanism,we use on-papillary ureteral reimplantation and oblique detrusor tunnel conforming to the natural direction of the ureter in modified Lich-Gregoir technique,which simplifies the surgical procedure and is proved to be safe and effective.The modified technique is a promising optional formula for robotic treatment of POM.

关 键 词：机器人辅助腹腔镜手术 原发性梗阻型巨输尿管 输尿管再植 

分 类 号：R699.4[医药卫生—泌尿科学]