摘要
目的:总结分析单一术者机器人辅助腹腔镜上尿路修复手术的技术经验及治疗效果。方法:回顾性分析2018年11月至2020年1月由单一术者完成的108例机器人辅助腹腔镜上尿路修复手术的临床资料,包括改良后离断肾盂成形术53例、肾盂瓣成形术11例、输尿管狭窄段切除再吻合术11例、输尿管狭窄切开自体舌黏膜修补术5例、输尿管狭窄切开阑尾补片修复术4例、输尿管膀胱再植术11例、术中精确测量法膀胱悬吊翻瓣术6例和改良回肠代输尿管术7例。手术成功定义为主观症状缓解且泌尿系超声提示肾积水缓解。结果:108例手术均成功完成,无中转普通腹腔镜及开放手术。改良后离断肾盂成形术,中位手术时间141 min(74~368 min),中位出血量20 mL(10~350 mL),中位术后住院时间4 d(3~19 d),手术成功率为94.3%。肾盂瓣成形术,中位手术时间159 min(110~222 min),中位出血量50 mL(20~150 mL),中位术后住院时间5 d(3~8 d),手术成功率为100%。输尿管狭窄段切除再吻合术,中位手术时间126 min(76~160 min),中位术中出血量20 mL(10~50 mL),中位术后住院时间5 d(4~9 d),手术成功率为100%。输尿管狭窄切开自体舌黏膜补片修补术,中位手术时间204 min(154~250 min),中位出血量30 mL(10~100 mL),中位术后住院时间6 d(4~7 d),手术成功率为100%。输尿管狭窄切开阑尾补片修复术,中位手术时间164 min(135~211 min),中位手术出血量75 mL(50~200 mL),中位术后住院日8.5 d(6~12 d),手术成功率为100%。输尿管膀胱再植术,中位手术时间149 min(100~218 min),中位术中出血量20 mL(10~50 mL),中位术后住院日7 d(5~10 d),手术成功率为90.9%。术中精确测量法膀胱悬吊翻瓣术,中位手术时间166 min(137~205 min),中位手术出血45 mL(20~100 mL),中位术后住院时间5 d(4~41 d),手术成功率为83.3%。改良回肠代输尿管手术,中位手术时间270 min(227~335 min),中位术中出血量100 mL(10~100 mL),中位术后住�
Objective:To summarize the experiences and outcomes of 108 robot-assisted laparoscopic upper urinary tract reconstruction surgeries conducted by a single surgeon.Methods:We consecutively and retrospectively reviewed 108 patients who underwent robot-assisted laparoscopic upper urinary tract reconstruction surgeries by a single surgeon from November 2018 to January 2020.The patient demographics,perioperative variables,postoperative complications and follow-up data were recorded.Fifty-three modified dismembered pyeloplasties(MDP),11 spiral flap pyeloplasties(SFP),11 ure-teroureterostomies(UUT),4 lingual mucosal onlay graft ureteroplasties(LMU),5 appendiceal onlay flap ureteroplasties(AU),11 ureteral reimplantations(UR),6 Boari flap-Psoas hitch surgeries(BPS)and 7 ileal ureter replacements(IUR)were enrolled finally.The success was defined as the improvement in subjective pain levels,and the improvement in the degree of hydronephrosis at ultrasound.Results:All the surgeries were successfully completed without open or laparoscopic conversion.The median operative time was 141 min(range:74-368 min),median blood loss was 20 mL(range:10-350 mL)and median hospital stay was 4 d(range:3-19 d)in MDP group,with the success rate of 94.3%.The median operative time was 159 min(range:110-222 min),median blood loss was 50 mL(range:20-150 mL)and median hospital stay was 5 d(range:3-8 d)in SFP group,with the success rate of 100%.The median operative time was 126 min(range:76-160 d),median blood loss was 20 mL(range:10-50 mL)and median hospital stay was 5 d(range:4-9 d)in UUT group,with the success rate of 100%.The median operative time was 204 min(range:154-250 min),median blood loss was 30 mL(range:10-100 mL)and median hospital stay was 6 d(range:4-7 d)in LMU group,with the success rate of 100%.The median operative time was 164 min(range:135-211 min),median blood loss was 75 mL(range:50-200 mL)and median hospital stay was 8.5 d(range:6-12 d)in AU group,with the success rate of 100%.The median operative time was 149 min(range:100-218
作者
程嗣达
李新飞
熊盛炜
樊书菠
王杰
朱伟杰
李子奡
丁光璞
俞婷
李万强
孙永明
杨昆霖
张雷
郝瀚
李学松
周利群
CHENG Si-da;LI Xin-fei;XIONG Sheng-wei;FAN Shu-bo;WANG Jie;ZHU Wei-jie;LI Zi-ao;DING Guang-pu;YU Ting;LI Wan-qiang;SUN Yong-ming;YANG Kun-lin;ZHANG Lei;HAO Han;LI Xue-song;ZHOU Li-qun(Department of Urology,Peking University First Hospital,Institute of Urology,Peking University,National Urological Cancer Center,Beijing 100034,China;Department of Urology,The Second Hospital of Sanming,Sanming 366000,Fujian,China;Department of Urology,The First College of Clinical Medical Science,Three Gorges University/Yichang Central People’s Hospital,Yichang 443003,Hubei,China;Department of Urology,Suqian People’s Hospital of Nanjing Drum Tower Hospital Group,Suqian 223800,Jiangsu,China)
出处
《北京大学学报（医学版）》
CAS
CSCD
北大核心
2020年第4期771-779,共9页
Journal of Peking University:Health Sciences
关键词
机器人手术
腹腔镜
上尿路
修复外科手术
Robotic surgical procedures
Laparoscopy
Upper urinary tract
Reconstructive surgical procedures
