经腹膜外机器人腹腔镜改良YV成形术治疗顽固性膀胱颈挛缩的疗效分析  

Extraperitoneal robot-assisted laparoscopic modified Y-V plasty for the treatment ofrefractory bladder neck contracture

作　　者：李金东[1,2] 张冲 吕蔡[1] 刘振湘[1] 白志明[1] 商学军[2] LI Jin-dong;ZHANG Chong;L Cai;LIU Zhen-xiang;BAI Zhi-ming;SHANG Xue-jun(Department of Urology,Haikou Hospital Affiliated to Xiangya School of Medicine,Central South University,Haikou 570100,China;Department of Urology,Nanjing School of Clinical Medicine,Southern Medical University/General Hospital of Eastern Theater Command,Nanjing,Jiangsu 210002,China)

机构地区：[1]中南大学湘雅医学院附属海口医院泌尿外科,海南海口570100 [2]南方医科大学南京临床医学院/东部战区总医院泌尿外科,江苏南京210002

出　　处：《中华男科学杂志》2024年第9期798-802,共5页National Journal of Andrology

摘　　要：目的:探讨经腹膜外机器人腹腔镜改良YV成形术治疗顽固性膀胱颈挛缩(BNC)的临床效果。方法:回顾性分析2020年9月至2023年1月期间中南大学湘雅医学院附属海口医院采用腹膜外途径的机器人腹腔镜改良YV成形术治疗的10例经尿道前列腺电切术后顽固性BNC患者临床资料。所有BNC患者均有反复尿道扩张以及≥2次经尿道手术处理瘢痕失败的病史。术前膀胱镜明确诊断,同时切除部分狭窄的瘢痕组织削平抬高的膀胱颈。手术采用达芬奇Si机器人系统,通过腹膜外途径的四孔入路方式进行手术。术中倒“T”型切开膀胱颈及前列腺部尿道狭窄环,切除前列腺部尿道腹侧3点→9点的倒“V”形瘢痕区域,3-0倒刺缝线连续全层缝合膀胱颈与倒“V”形尿道,留置F20硅胶导尿管2周。术后3个月进行膀胱镜检查、最大尿流率检测、国际前列腺症状评分(IPSS)和生活质量(QOL)评分。结果:10例患者均成功实施手术。术后3个月与术前比较:最大尿流率显著提高[(20.3±1.77)ml/s vs(3.65±1.27 ml/s]、IPSS评分和QOL评分均显著改善[分别为(5.9±2.02)分vs(30±1.15)分和(1.3±0.95)分vs(5.2±0.79)分],差异均有统计学意义(P<0.05);膀胱镜检查显示膀胱颈宽阔且平坦,膀胱瓣存活且血运良好。中位随访13.2个月,均达到治愈标准。结论:经腹膜外机器人腹腔镜改良YV成形术为顽固性BNC提供了一种新的尿路重建方式,具有微创、高效、成功率高的优势。Objective:To investigate the clinical effect of extraperitoneal robot-assisted laparoscopic modified Y-V plasty(LMYVP)in the treatment of refractory bladder neck contracture(BNC).Methods:We retrospectively analyzed the clinical data on 10 cases of refractory BNC after transurethral resection of the prostate between September 2020 and January 2023,all with a history of recurrent urethral dilatation and at least two failures in transurethral surgical treatment of scarring.After definite diagnosis and removal of some of the scar tissues to flatten the elevated bladder neck under the cystoscope,we performed robot-assisted LMYVP using the da Vinci Si robotic system and a four-port extraperitoneal approach.The surgical procedure involved an inverted T-shaped incision in the bladder neck and urethral stricture ring,an inverted V-shaped excision of the scar area at the 3-9 o'clock position on the ventral side of the prostatic urethra,continuous full-layer suturing of the bladder neck and inverted V-shaped urethra with 3-0 barbed thread,and indwelling of an F20 silicone catheter for 2 weeks.At 3 months after surgery,we performed cystoscopic examination,measured the maximum urinary flow rate(Qmax),and obtained the IPSS and quality of life(QOL)scores of the patients.Results:Operations were successfully completed in all the cases.At 3 months after surgery,the patients showed significantly increased Qmax([3.65±1.27]vs[20.3±1.77]ml/s,P<0.05),IPSS(5.9±2.02 vs 30±1.15,P<0.05)and QOL score(1.3±0.95 vs 5.2±0.79,P<0.05)compared with the baseline.Cystoscopy revealed a wide and flat bladder neck with good survival and hemodynamics of the bladder flap.All the patients met the criteria for clinical cure at a median follow-up of 13.2 months.Conclusion:Extraperitoneal robot-assisted LMYVP provides a new strategy for urinary tract reconstruction in the management of refractory BNC,with the advantages of minimal invasiveness,high efficiency and high success rate.

关 键 词：膀胱颈挛缩 改良YV成形术 机器人辅助腹腔镜 

分 类 号：R699.5[医药卫生—泌尿科学]