机器人辅助腹腔镜下“SPIFFS”三步法肾盂成形术联合肾固定术治疗肾盂输尿管连接部梗阻合并肾下垂的临床应用  

Clinical application of the "SPIFFS" three-step method in robot-assisted laparoscopic pyeloplasty combined with nephropexy for the treatment of ureteropelvic junction obstruction with nephroptosis

作　　者：付强锋 许皓翔 杨成林 曾圣涛 杨悦 张小明 肖远松 王尉 FU Qiangfeng;XU Haoxiang;YANG Chenglin;ZENG Shengtao;YANG Yue;ZHANG Xiaoming;XIAO Yuansong;WANG Wei(Department of Urology,General Hospital of Southern Theater Command,First School of Clinical Medicine,Southern Medical University,Guangzhou,510010,China)

机构地区：[1]南方医科大学第一临床医学院中国人民解放军南部战区总医院泌尿外科,广州510010

出　　处：《临床泌尿外科杂志》2025年第3期195-199,205,共6页Journal of Clinical Urology

基　　金：广州市科技计划项目(No:2024A03J0641)。

摘　　要：目的:探讨经腹腔路径机器人辅助腹腔镜下“SPIFFS”三步法肾盂成形术治疗肾盂输尿管连接部梗阻合并肾下垂的应用效果。方法:回顾性分析2022年5月—2024年3月中国人民解放军南部战区总医院收治的10例行机器人辅助腹腔镜下“SPIFFS”三步法肾盂成形术联合肾固定术治疗肾盂输尿管连接部梗阻合并肾下垂患者的临床资料。统计患者的手术时间、术中出血量、术后住院时间、引流管留置时间、术后取出输尿管支架时间,评估术后效果等情况。结果:本研究10例手术均顺利完成,无中转开放手术。手术时间136~182 min,平均(157.9±23.4) min;术中出血量75~175 mL,平均(126.5±33.7) mL;术后住院时间5~8 d,平均(6.3±1.2) d;引流管留置时间4~6 d,平均(5.0±0.8) d;术后取出输尿管支架时间4~8周,平均(5.1±1.3)周;术后1周患者症状明显减轻。术后随访6~24个月,术后1个月影像学显示患侧肾盂前后径1.2~2.6 cm,平均(1.8±0.5) cm;术后3个月复查发射型计算机断层扫描(emission computed tomography,ECT)显示肾功能有所改善,静脉泌尿系造影(intravenous urography,IVU)显示患侧肾积水明显好转。结论:机器人辅助腹腔镜下“SPIFFS”三步法肾盂成形术联合肾固定术治疗肾盂输尿管梗阻合并肾下垂患者,可有效保护肾功能,并发症少,值得临床推广。Objective:To investigate the clinical feasibility of the "SPIFFS" three-steps method in transperitoneal robot-assisted laparoscopic pyeloplasty combined with nephropexy for the treatment of ureteropelvic junction obstruction with nephroptosis.Methods:The clinical data of 10 cases of robot-assisted laparoscopic SPIFFS three-steps pyeloplasty combined with renal fixation for the treatment of renal pelvic-ureteral junction obstruction combined with renal ptosis were retrospectively analyzed from May 2022 to March 2024.Patients' operation time,intraoperative bleeding,postoperative hospitalization time,drainage tube retention time,postoperative removal of ureteral stents,and assessment of postoperative outcomes were statistically analyzed.Results:All 10 surgeries in this study were successfully completed without intermediate open surgery.The operation time was(157.9±23.4) min(range:136-182 min),and intraoperative bleeding was(126.5±33.7) mL(range:75-175 mL).Postoperative hospitalization time was(6.3±1.2) days(range:5-8 days),and drainage tube retention time was(5.0±0.8) days(range:4-6 days).Ureteral stent was removed at postoperative time(5.1±1.3) weeks(range:4-8 weeks),and the patients' symptoms significantly reduced at 1 week postoperatively.Postoperative follow-up period was 6-24 months.Imaging showed anteroposterior diameter of the renal pelvis on the affected side(1.8±0.5) cm(range:1.2-2.6 cm).Review of ECT at 3 months postoperatively showed improvement in renal function,and review of IVU showed significant improvement in hydronephrosis on the affected side.Conclusion:The robot-assisted laparoscopic "SPIFFS" three-steps pyeloplasty combined with nephropexy for the treatment of ureteropelvic obstruction with nephroptosis can effectively protect renal function,with few complications,so is worthy of clinical promotion.

关 键 词：机器人辅助腹腔镜下肾盂成形术 肾固定术 肾盂输尿管连接部梗阻 肾下垂 

分 类 号：R693[医药卫生—泌尿科学]