机器人辅助腹腔镜与传统腹腔镜下肾盂成形术在治疗儿童肾盂输尿管连接部梗阻中的对比分析  

Comparative analysis of robot-assisted and conventional laparoscopic pyeloplasty in the treatment of ureteropelvic junction obstruction in children

作　　者：刘慧 范晓晓 李德儒 王东明 李爱武 LIU Hui;FAN Xiaoxiao;LI Deru;WANG Dongming;LI Aiwu(Department of Pediatric Surgery,Qilu Hospital,Shandong University,Jinan 250012,China)

机构地区：[1]山东大学齐鲁医学院小儿外科,山东济南250012

出　　处：《机器人外科学杂志（中英文）》2023年第5期477-484,共8页Chinese Journal of Robotic Surgery

摘　　要：目的:对比分析机器人辅助腹腔镜和传统腹腔镜下肾盂成形术治疗儿童肾盂输尿管连接部梗阻(Ureteropelvic Junction Obstruction,UPJO)的临床疗效,总结机器人辅助腹腔镜肾盂成形术的临床经验及优势。方法:回顾性分析2020年7月—2022年10月在山东大学齐鲁医院小儿外科接受机器人辅助腹腔镜肾盂成形术(Robot-assisted Laparoscopic Pyeloplasty,RALP)(RALP组,n=22)及传统腹腔镜肾盂成形术(Laparoscopic Pyeloplasty,LP)(LP组,n=48)治疗的患儿的临床资料,并对两组患儿的一般临床资料、手术时间、肾盂输尿管吻合时间、术中失血量、术后住院天数、住院总费用、术后短期并发症、手术治疗效果等指标进行对比,分析两种手术方式的优劣。结果:两组术后肾盂前后径(Anteroposterior Diameter,APD)较术前均有明显减小(P<0.001)。与LP组相比,RALP组的肾盂输尿管吻合时间更短[(27.95±9.52)min Vs(41.17±8.34)min,P<0.001],住院总费用更高[5.05(4.78,5.26)万元Vs 3.63(3.38,3.84)万元,P<0.001],而两组的手术时间、术中出血量、术后住院天数、术后并发症发生率、手术前后APD差值比较,差异均无统计学意义。结论:机器人辅助腹腔镜肾盂成形术是治疗儿童UPJO安全、有效的手段。与传统腹腔镜肾盂成形术相比,机器人辅助腹腔镜肾盂成形术具有术野清晰、缝合精准、术中肾盂输尿管吻合时间短、学习曲线短、符合人体工程学等优势,不足之处主要在于其住院费用较高,Trocar孔瘢痕稍大。Objective:To compare and analyze the clinical efficacy of robot-assisted and conventional laparoscopic pyeloplasty in the treatment of ureteropelvic junction obstruction(UPJO)in children,and summarize the clinical experience and advantages of robot-assisted laparoscopic pyeloplasty.Methods:A retrospective analysis was performed on the clinical data of children treated with robot-assisted laparoscopic pyeloplasty(RALP group,n=22)and conventional laparoscopic pyeloplasty(LP group,n=48)in the Department of Pediatric Surgery of Qilu Hospital of Shandong University from July 2020 to October 2022.The general clinical data,operative time,ureteropelvic anastomosis time,intraoperative blood loss,postoperative hospital stay,total hospitalization costs,postoperative short-term complications,and surgical treatment effects of the two groups were compared to analyze advantages and disadvantages of the two surgical methods.Results:The postoperative APD(Anteroposterior Diameter)of the two groups was significantly lower than that before surgery(P<0.001).Compared with LP,the time of ureteropelvic anastomosis in children with RALP was shorter[(27.95±9.52)min Vs(41.17±8.34)min,P<0.001],and the total cost of hospitalization was higher[50.5(47.8,52.6)thousand CNY Vs 36.3(33.8,38.4)thousand CNY(P<0.001)],while there were no significant differences in operative time,blood loss,postoperative hospital stay,postoperative complication rate,and APD difference before and after surgery.Conclusion:Robot-assisted laparoscopic pyeloplasty is a safe and effective way to treat UPJO in children.Compared with the conventional laparoscopic pyeloplasty,it has clearer field of vision,more precise suturing,shorter ureteropelvic anastomosis time,shorter learning curve,and more ergonomic position.However,it faces the disadvantages of higher cost of hospitalization and slightly larger scar of the Trocar hole.

关 键 词：肾盂输尿管连接部梗阻 机器人辅助手术 腹腔镜手术 肾盂成形术 儿童 

分 类 号：R692[医药卫生—泌尿科学]