机器人辅助腹腔镜上尿路重建日间手术模式的应用探索  

Exploration of the application of robot-assisted laparoscopic upper tract urological reconstruction in day surgery mode

作　　者：蔡超[1] 彭思桥 刘旸[1] 刘融歆 麦赞林[1] 曾滔[1] 何涛 郑玉玲[1] 赖美玉 张敏[1] 刘永达[1] CAI Chao;PENG Siqiao;LIU Yang;LIU Rongxin;MAI Zanlin;ZENG Tao;HE Tao;ZHENG Yuling;LAI Meiyu;ZHANG Min;LIU Yongda(Department of Urology,the First Affiliated Hospital,Guangzhou Medical University,Guangdong Provincial Key Laboratory of Urological Diseases,Guangzhou Medical University,Guangdong Engineering Research Center of Urinary Minimally Invasive Surgery,Robot and Intelligent Equipment,Guangzhou Medical University,Guangzhou Institute of Urology,Guangzhou Medical University,Guangzhou,510000,China)

机构地区：[1]广州医科大学附属第一医院泌尿外科广东省泌尿疾病重点实验室泌尿微创手术机器人与智能装备广东省工程研究中心广州泌尿外科研究所,广州510000

出　　处：《临床泌尿外科杂志》2025年第3期200-205,共6页Journal of Clinical Urology

基　　金：广州市科技计划项目(No:202201020511)。

摘　　要：目的:总结机器人辅助腹腔镜上尿路重建日间手术的经验,探讨此模式的疗效及安全性。方法:前瞻性收集广州医科大学附属第一医院2023年8月—2024年3月同意接受日间机器人辅助腹腔镜肾盂成形术和输尿管端端吻合术的患者相关信息。手术成功为在拔除输尿管内支架后,患者无腰痛症状、无尿路感染、肾积液改善或稳定。完成日间手术是指在24 h内完成手术及出入院流程,且患者在出院后能够耐受进食、无腹痛腹胀,并且在拔除输尿管内支架前未再次入院,且排除术后患者外院转诊康复的情况。结果:入组11例患者中,9例肾盂输尿管成形术(经脐多臂单孔8例、多臂多孔1例),2例多臂多孔输尿管端端吻合术,所有患者均顺利完成手术。10例单侧术式的平均手术时间为(84.90±29.78)min,1例同期双侧手术的手术时间为200 min。所有患者术中出血量为(14.09±8.21)mL。9例(82%)患者术中未留置腹腔引流管。术后平均(5.45±0.50)h流质饮食,胃肠道恢复时间平均为(27.55±14.40)h。术后12、24 h的视觉模拟评分法(visual analogue scale,VAS)评分分别为(1.27±0.45)分、(1.09±0.29)分。日间手术完成率100%,且出院后至拔除输尿管内支架前再入院率为0。拔除双J管后中位随访时间为8(6,10)个月,手术成功率100%。结论:对于肾盂成形术和输尿管端端吻合术,机器人辅助腹腔镜上尿路重建手术可安全有效地实现日间模式,在保证手术成功率的前提下,进一步缩短住院时间、提高就医体验和节省医疗资源。Objective:To summarize the experience of robot-assisted laparoscopic upper urinary tract reconstruction in day surgery,and explore the efficacy and safety of this mode.Methods:Clinical data from patients undergoing day-case robot-assisted laparoscopic pyeloplasty and ureteroureterostomy between August 2023 and March 2024 at First Affiliated Hospital of Guangzhou Medical University were prospectively collected.The surgical success rate was defined by the absence of postoperative flank pain or urinary tract infection,and the improvement or stabilization of hydronephrosis following the removal of the ureteral stent.The completion of a day-case surgery implies the accomplishment of the surgical procedure and discharge within a 24-hour period,with the patient demonstrating the ability to tolerate oral intake and exhibiting no abdominal pain or distension post-discharge,and no readmission prior to the removal of the ureteral stent,excluding cases transferred to other hospitals for rehabilitation Results:A total of 11 patients were enrolled,including:9 cases of pyeloplasty(8 with multi-port single-hole through the umbilicus,1 with multi-port multi-hole)and 2 cases of multi-port multi-hole ureteroureterostomy.All patients successfully underwent surgery.The mean operative time for the 10 unilateral procedures was(84.90±29.78)minutes,and the operative time for 1 simultaneous bilateral surgery was 200 minutes.All patients intraoperative blood loss was(14.09±8.21)mL.Nine cases(82%)did not have an abdominal drainage tube left in place intraoperatively.The average time to initiate a liquid diet postoperatively was(5.45±0.50)hours,and the gastrointestinal recovery time was(27.55±14.40)hours.The VAS score at 12,24 hours postoperatively were(1.27±0.45),(1.09±0.29),respectively.The day-case surgery completion rate was 100%,with a readmission rate before the removal of the ureteral stent after discharge is 0.The median follow-up time after double J stent removal was 8(6,10)months,the surgical success rate was 100%.Conclusion:

关 键 词：日间手术 上尿路重建 肾盂成形术 输尿管端端吻合术 

分 类 号：R693[医药卫生—泌尿科学]