机器人辅助腹腔镜技术同期处理UPJO合并继发结石病例的临床经验总结
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摘要
目的:总结解放军总医院泌尿外科应用机器人辅助腹腔镜技术同期治疗肾盂输尿管连接部狭窄(UPJO)及继发结石病例的临床经验。方法:回顾性分析2014年3月~2016年3月应用达芬奇机器人实施的18例经腹腔途径行机器人辅助腹腔镜肾盂成形术同期行肾盂探查取石术的临床资料。结果:18例肾盂成形术及肾盂探查取石术均同期完成,无残余结石,无副损伤及中转开放。其中左侧12例,右侧6例,所有病例均术前通过静脉肾盂造影及CT检查明确为肾盂输尿管连接部梗阻且合并继发结石,积水为中到重度,结石1~3块,大小1~3cm,手术时间60~110min,平均(80±14)min,术中出血量10~20ml,术中均未输血,结石均完整取出,术后1例出现吻合口漏尿,给予充分引流后于术后10天吻合口愈合,余17例恢复顺利,术后5~10天拔除引流管,术后住院日6~10d,平均6.3d,所有病例均获得随访6~30个月,随访期内肾积水无明显加重,结石无复发。结论:机器人辅助腹腔镜技术治疗UPJO合并继发结石安全可行,可同期行肾盂成形术及结石取出,具有创伤小,出血少,高清成像视野清晰,机械手臂操作精细,肾盂裁剪精准,对位缝合精确等优点。因机械手臂可弯曲,可同期行肾盂肾盏探查取出继发结石,减少患者二次手术风险,术后恢复快。对UPJO合并结石的患者,机器人辅助腹腔镜技术是较好选择。
Objective:To summarize our experience in robot-assisted laparoscopic surgery for UPJO with secondary calculus.Method:A retrospective analysis of the clinical data of 18 patients with UPJO with secondary calculus which were treated by transperitoneal Da Vinci robot-assisted laparoscopic Anderson-Hynes dismembered pyeloplasty and pyeloureterolithotomy from March 2014 to March 2016 was done.Result:All the operations were finished successfully with no residual stone,subsidiary injury or conversion to open operation.The lesions were located on the left side in 12 cases,and on the right side in 6cases.Success was defined as both intravenous pyelography and CT.Of the 18 patients,the severity of the hydronephrosis was from moderate to severe,the number of the calculus was from 1to 3,the size of the stone was from 1to 3cm.Average operative time was(80±14)min,ranging from 60 to 110min.Estimated blood loss ranged from 10 to 20ml without blood transfusion.All operations were successfully completed without residual stone.Urine leakage occurred postoperatively in one case,and was cured after ten days with adequate drainage.Drainage tube was removed in 5-10 days and incisions healed well.Average postoperative hospital stay was 6.3(range,6-10)days.During the follow-up period of 6to 30 months,the hydronephrosis relieved and there was no stone reoccurrence.Conclusion:Robotic pyeloplasty has gained prominency in that it offers the advantages of three-dimensional magnified images,robotic instruments with higher manipulation facilities,higher rates of success in intracorporeal suturing after pyelic-ureteral lithotripsy,and shorter operative time.Robot-assisted laparoscopic surgery in the treatment of UPJO with secondary calculus is an effective minimally invasive method with less bleeding,and improved surgical outcomes.
Objective:To summarize our experience in robot-assisted laparoscopic surgery for UPJO with secondary calculus.Method:A retrospective analysis of the clinical data of 18 patients with UPJO with secondary calculus which were treated by transperitoneal Da Vinci robot-assisted laparoscopic Anderson-Hynes dismembered pyeloplasty and pyeloureterolithotomy from March 2014 to March 2016 was done.Result:All the operations were finished successfully with no residual stone,subsidiary injury or conversion to open operation.The lesions were located on the left side in 12 cases,and on the right side in 6cases.Success was defined as both intravenous pyelography and CT.Of the 18 patients,the severity of the hydronephrosis was from moderate to severe,the number of the calculus was from 1to 3,the size of the stone was from 1to 3cm.Average operative time was(80±14)min,ranging from 60 to 110min.Estimated blood loss ranged from 10 to 20ml without blood transfusion.All operations were successfully completed without residual stone.Urine leakage occurred postoperatively in one case,and was cured after ten days with adequate drainage.Drainage tube was removed in 5-10 days and incisions healed well.Average postoperative hospital stay was 6.3(range,6-10)days.During the follow-up period of 6to 30 months,the hydronephrosis relieved and there was no stone reoccurrence.Conclusion:Robotic pyeloplasty has gained prominency in that it offers the advantages of three-dimensional magnified images,robotic instruments with higher manipulation facilities,higher rates of success in intracorporeal suturing after pyelic-ureteral lithotripsy,and shorter operative time.Robot-assisted laparoscopic surgery in the treatment of UPJO with secondary calculus is an effective minimally invasive method with less bleeding,and improved surgical outcomes.
引文
1 Berkman D S,Landman J,Gupta M.Treatment outcomes after endopyelotomy performed with or without simultaneous nephrolithotomy:10-year experience[J].J Endourol,2009,23(9):1409-1413.
2 Bernardo N O,Liatsikos E N,Dinlenc C Z,et al.Stone recurrence after endopyelotomy[J].Urology,2000,56(3):378-381.
3 兰东阳,庞自力,章小平,等.经皮肾镜取石术并同期冷刀内切开治疗UPJO的疗效观察[J].临床泌尿外科杂志,2015,30(5):429-432.
4 Dobry E,Usai P,Studer U E,et al.Is antegrade endopyelotomy really less invasive than open pyeloplasty[J].Urol Int,2007,79(2):152-6.
5 Jacobs B L,Kaufman S R,Morgenstern H,et al.Trends in the treatment of adults with ureteropelvic junction obstruction[J].J Endourol,2013,27(3):355-360.
6 Skolarikos A,Dellis A,Knoll T.Ureteropelvic obstruction and renal stones:etiology and treatment[J].Urolithiasis,2015,43(1):5-12.
7 Chen Z,Zhou P,Yang Z Q,et al.Transperitoneal minilaparoscopic pyeloplasty and concomitant ureteroscopyassisted pyelolithotomy for ureteropelvic junction obstruction complicated by renal caliceal stones[J].PLoS One,2013,8(1):e55026.
8 Stein R J,Turna B,Nguyen M M,et al.Laparoscopic pyeloplasty with concomitant pyelolithotomy:technique and outcomes[J].J Endourol,2008,22(6):1251-1255.
9 Patel T,Kellner C P,Katsumi H,et al.Efficacy of endopyelotomy in patients with secondary ureteropelvic junction obstruction[J].J Endourol,2011,25(4):587-591.
10 高旭,王海峰,鲁欣,等.机器人辅助的腹腔镜与普通腹腔镜下UPJ成型的比较研究[J].微创泌尿外科杂志,2012,1(1):70-72.
11 郑霁,鄢俊安,李为兵,等.达芬奇机器人辅助腹腔镜联合输尿管硬镜一期治疗肾盂输尿管连接部梗阻合并肾结石[J].微创泌尿外科杂志,2014,3(4):197-200.
2 Bernardo N O,Liatsikos E N,Dinlenc C Z,et al.Stone recurrence after endopyelotomy[J].Urology,2000,56(3):378-381.
3 兰东阳,庞自力,章小平,等.经皮肾镜取石术并同期冷刀内切开治疗UPJO的疗效观察[J].临床泌尿外科杂志,2015,30(5):429-432.
4 Dobry E,Usai P,Studer U E,et al.Is antegrade endopyelotomy really less invasive than open pyeloplasty[J].Urol Int,2007,79(2):152-6.
5 Jacobs B L,Kaufman S R,Morgenstern H,et al.Trends in the treatment of adults with ureteropelvic junction obstruction[J].J Endourol,2013,27(3):355-360.
6 Skolarikos A,Dellis A,Knoll T.Ureteropelvic obstruction and renal stones:etiology and treatment[J].Urolithiasis,2015,43(1):5-12.
7 Chen Z,Zhou P,Yang Z Q,et al.Transperitoneal minilaparoscopic pyeloplasty and concomitant ureteroscopyassisted pyelolithotomy for ureteropelvic junction obstruction complicated by renal caliceal stones[J].PLoS One,2013,8(1):e55026.
8 Stein R J,Turna B,Nguyen M M,et al.Laparoscopic pyeloplasty with concomitant pyelolithotomy:technique and outcomes[J].J Endourol,2008,22(6):1251-1255.
9 Patel T,Kellner C P,Katsumi H,et al.Efficacy of endopyelotomy in patients with secondary ureteropelvic junction obstruction[J].J Endourol,2011,25(4):587-591.
10 高旭,王海峰,鲁欣,等.机器人辅助的腹腔镜与普通腹腔镜下UPJ成型的比较研究[J].微创泌尿外科杂志,2012,1(1):70-72.
11 郑霁,鄢俊安,李为兵,等.达芬奇机器人辅助腹腔镜联合输尿管硬镜一期治疗肾盂输尿管连接部梗阻合并肾结石[J].微创泌尿外科杂志,2014,3(4):197-200.