达芬奇手术机器人在输尿管膀胱再植术中的应用  

Application of the Da Vinci robot-assisted laparoscopic ureteral reimplantation

作　　者：王泠霏 洪扬刚 游灿灿 夏立广[1] 林正秀[1] 陈聪德[1] WANG Lingfei;HONG Yanggang;YOU Cancan;XIA Liguang;LIN Zhengxiu;CHEN Congde(Department of Pediatric Surgery,the Second Affiliated Hospital&Yigying Children s Hospital of Wenzhou Medical University,Wenzhou 325027,China;The Second School of Medicine,Wenzhou Medical University Wenzhou 325035,China)

机构地区：[1]温州医科大学附属第二医院育英儿童医院儿童外科学科,浙江温州325027 [2]温州医科大学第二临床医学院,浙江温州325035

出　　处：《温州医科大学学报》2024年第11期880-884,888,共6页Journal of Wenzhou Medical University

摘　　要：目的:探讨达芬奇机器人辅助腹腔镜下Lich-Gregoir术治疗儿童原发性膀胱输尿管反流(VUR)的临床疗效。方法:回顾性分析2022年7月至2023年7月在温州医科大学附属第二医院育英儿童医院儿童泌尿外科收治的31例原发性VUR患儿的临床资料,其中男15例,女16例,均行达芬奇机器人辅助腹腔镜下Lich-Gregoir术。患儿平均年龄(57.3±20.8)个月,其中单侧17例,双侧14例。结果:患儿均采用达芬奇机器人辅助腹腔镜下Lich-Gregoir输尿管再植术,单侧输尿管平均手术时间为(142.6±22.3)min,双侧输尿管平均手术时间为(176.8±32.6)min。术中患侧输尿管直径为(9.5±2.9)mm,黏膜下隧道长度为35(35,50)mm,术后留置导尿管时间(4.8±1.2)d,术后住院时间6(5,6)d。其中1例术中行输尿管裁剪,4例术中同时行腹股沟斜疝修补。1例患儿在术后2d出现发热、尿常规白细胞升高,考虑为术后尿路感染,继续静脉使用抗生素7d后症状及尿检好转,其余患儿均无发热、排尿异常、腹痛等症状。出院后随访时间为6~16个月,其间1例患儿出现尿路感染,经抗感染治疗后症状消失。B超均未发现患侧输尿管肾积水加重。结论:达芬奇机器人辅助腹腔镜下Lich-Gregoir输尿管再植术可较为安全、有效地治疗儿童原发性VUR,但仍需更长期的临床实践来证明其价值。Objective:To assess the clinical efficacy of the Da Vinci robot-assisted laparoscopic Lich-Gregoir procedure in managing primary vesicoureteral reflux in children.Methods:A retrospective analysis was conducted on the clinical data of 31 children diagnosed with vesicoureteral reflux and treated at the Second Affiliated Hospital&Yuying Children’s Hospital of Wenzhou Medical University between July 2022 and July 2023.The cohort consisted of 15 boys and 16 girls,all of whom underwent the robot-assisted laparoscopic ureteral reimplantation,aged(57.3±20.8)months in average,with 17 cases of unilateral reflux and 14 bilateral reflux.Results:All cases underwent the Da Vinci robot-assisted laparoscopic Lich-Gregoir ureteral reimplantation.The average duration of surgery for unilateral ureter was(142.6±22.3)min,and(176.8±32.6)min for bilateral ureter.The intraoperative diameter of the affected ureter was(9.5±2.9)mm,with a submucosal tunnel length of 35(35,50)mm.The postoperative catheterization duration was(4.8±1.2)d,and the postoperative hospital stay was 6(5,6)d.During surgery,ureteral trimming occurred in 1 case,and simultaneous repair of inguinal hernia in 4 cases.One child developed fever and had an elevated white blood cell count in urine on the second day after surgery,suspected to be postoperative urinary tract infection.Given the intravenous antibiotic for 7 days,symptoms and urine test results improved.Other children did not have fever,abnormal urination,abdominal pain,or other symptoms.Follow-up time after discharge ranged from 6 to 16 months,during which one child developed urinary tract infection.Symptoms disappeared after anti-infective treatment,and no aggravation of ureteral and renal pelvis dilation was observed in the ultrasound examinations on the affected side.Conclusion:The Da Vinci robot-assisted laparoscopic Lich-Gregoir ureteral reimplantation emerges as a relatively safe and effective method for treating primary vesicoureteral reflux in children.Nevertheless,longer-term clinical practice is n

关 键 词：儿童 原发性膀胱输尿管反流 机器人手术 输尿管膀胱再植术 

分 类 号：R726[医药卫生—儿科]