机器人辅助改良舌黏膜补片修复复杂输尿管狭窄的临床应用  

Robotic-assisted laparoscopic modified ventral onlay lingual mucosal graft in complex ureteral stricture construction: experience of eight cases

作　　者：许皓翔 杨成林 王尉 曹智 胡正飞 张小明 肖远松 Xu Haoxiang;Yang Chenglin;Wang Wei;Cao Zhi;Hu Zhengfei;Zhang Xiaoming;Xiao Yuansong(The First School of Clinical Medicine,Southern Medical University,Department of Urology,General Hospital of Southern Theater Command,Guangzhou 510010,China)

机构地区：[1]南方医科大学第一临床医学院南部战区总医院泌尿外科,广州510010

出　　处：《中华外科杂志》2023年第11期1012-1017,共6页Chinese Journal of Surgery

基　　金：广州市科技计划(202002030030);广东省基础与应用基础研究基金(2020A1515010044)。

摘　　要：目的:探讨采用机器人辅助腹腔镜下改良舌黏膜补片修复复杂输尿管狭窄的治疗效果。方法:回顾性分析2022年5月—10月南部战区总医院泌尿外科收治的8例输尿管狭窄患者的临床资料。男性6例,女性2例,年龄(45.1±10.2)岁(范围:34~64岁),体重指数(24.6±2.0)kg/m 2(范围:20.7~26.6 kg/m 2)。左侧5例,右侧3例,输尿管狭窄长度(3.1±0.7)cm(范围:2.2~4.5 cm)。术前血肌酐(113.8±22.3)μmol/L(范围:96~165μmol/L)。术中采用后壁黏膜岛状连接输尿管正常两断端预缝合+狭窄段切除+后壁增强吻合+舌黏膜补片输尿管成形术,根据实际狭窄情况取舌黏膜长度2.5~5.0 cm,宽度1.0~1.5 cm,并用大网膜包裹修复段输尿管。记录患者的手术情况、并发症以及近期的随访情况。结果:本研究8例手术均在机器人辅助腹腔镜下顺利完成,无中转开放手术。手术时间(226.9±22.8)min(范围:210~255 min),术中出血量(93.8±25.9)ml(范围:75~150 ml),术后引流管留置时间(4.8±1.3)d(范围:3~7 d),术后住院时间(11.1±3.6)d(范围:9~14 d)。术后1周患者发音准确、吐字清晰,可正常进食。术后4~8周拔除双J管。随访时间3~9个月,影像学检查见患侧肾积水明显改善,患侧肾盂分离(1.4±0.8)cm(范围:0~2.3 cm)。术后复查血肌酐(100.1±24.9)μmol/L(范围:76~155μmol/L)。术后3个月行输尿管镜检复查,可见术侧输尿管全程通畅,黏膜正常。结论:机器人辅助腹腔镜下改良舌黏膜补片修复输尿管狭窄,近期效果好,为修复输尿管狭窄提供了一种手术选择。Objective To examine the efficacy of robot-assisted laparoscopic modified ventral onlay lingual mucosal graft for complex ureteral stricture.Methods The clinical data of 8 patients with ureteral stricture admitted to the Department of Urology,General Hospital of Southern Theater Command from May to October 2022 were retrospectively analyzed.There were 6 males and 2 females,aged(45.1±10.2)years(range:34 to 64 years),body mass index(24.6±2.0)kg/m2(range:20.7 to 26.6 kg/m2).Five cases on the left side,3 cases on the right side,the length of the ureteral structure was(3.1±0.7)cm(range:2.2 to 4.5 cm).The value of preoperative serum creatinine was(113.8±22.3)μmol/L(range:96 to 15μmol/L).Before excising the structure segment,the titched anastomosed part of the dorsal wall of the ureter,and then the posteriorly augmented anastomotic,the remaining ventral side was augmented with a onlay lingual mucosa graft,then the omentum flap was used to wrap the reconstructed ureteral segment.The lingual mucosa graft with a length of 2.5 to 5.0 cm and a width of 1.0 to 1.5 cm was cut according to the actual structure.The surgery information of the patient,complications,and recent follow-up were recorded.Results The operation under robot-assisted laparoscopy was performed successfully in the 8 patients without conversion to open surgery.The duration of the operation was(226.9±22.8)minutes(range:210 to 255 minutes),estimated blood loss was(93.8±25.9)ml(range:75 to 150 ml),the retention time of the postoperative drainage tube was(4.8±1.3)days(range:3 to 7 days),and the duration of postoperative hospitalization was(11.1±3.6)days(range:9 to 14 days).One week after the operation,the patient could pronounce correctly,enunciate clearly,and eat normally.Double J tubes were removed 4 to 8 weeks after the operation.The follow-up time in this group was 3 to 9 months,the follow-up patients underwent imaging and other examinations,which showed a significant improvement in hydronephrosis on the affected side,and the value of renal pelvic s

关 键 词：输尿管梗阻 修复外科手术 机器人 腹腔镜 输尿管成形术 舌黏膜 

分 类 号：R693.2[医药卫生—泌尿科学]