机器人与开放手术治疗复发性肾盂输尿管连接部梗阻的比较研究
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摘要
目的:比较机器人与开放手术治疗复发性肾盂输尿管连接部梗阻(UPJO)的临床疗效。方法:回顾性分析2012年4月～2018年10月我院采用机器人和开放手术治疗治疗的24例复发性UPJO的临床资料,并对两组患者的一般临床资料、手术时间、术中失血量、术后引流管留置时间、术后住院时间、术后并发症和治疗效果进行对比分析。结果:所有手术均成功完成,机器人手术组无中转开放手术病例。两组手术时间、术中失血量、术后引流管留置时间和术后并发症发生率比较差异无统计学意义(P>0.05)。机器人手术组术后住院时间明显短于开放手术组(P=0.013)。术后中位随访时间为27(4～84)个月,有1例开放手术组患者失访,其余23例患者腰痛症状消失,超声检查提示患肾积水程度明显减轻,静脉尿路造影提示上尿路引流通畅。结论:机器人手术治疗复发性UPJO安全、有效,与传统开放手术比较,机器人手术创伤小、术后恢复快、住院时间更短。随着机器人手术的日益普及,机器人手术将逐渐替代开放手术,成为复发性UPJO的新选择。
Objective:To compare the clinical efficacy between robot-assisted pyeloplasty and open pyeloplasty for treatment of recurrent ureteropelvic junction obstruction(UPJO).Method:We retrospectively reviewed the medical records of patients with recurrent UPJO who received robot-assisted pyeloplasty or open pyeloplasty in our hospital.The general information,operative time,intraoperative blood loss,postoperative indwelling time of drainage tube,postoperative hospital stay,postoperative complication rate and treatment outcomes were compared between the two groups.Result:All procedures were performed successfully,and there was no conversion to open surgery in the robot group.There was no significant difference between the two groups in terms of operative time,intraoperative blood loss,postoperative indwelling time of drainage tube or complication rate(P>0.05).Patients in the open group had a significantly longer postoperative hospital stay than that in the robot group(P=0.013).Median follow-up period was 27(range,4-84)months.One patient lost follow-up,and the other 23 patients had improvement in symptoms and degree of hydronephrosis through ultrasound and the intravenous urography determined drainage patency.Conclusion:Compared with open pyeloplasty,robot-assisted pyeloplasty is safe and effective for patients with recurrent UPJO in terms of less injury,quicker postoperative recovery,and shorter postoperative stay.With the increasing popularity of robotic surgery,robot-assisted pyeloplasty will gradually replace open surgery and become a new treatment choice for patients with recurrent UPJO.
Objective:To compare the clinical efficacy between robot-assisted pyeloplasty and open pyeloplasty for treatment of recurrent ureteropelvic junction obstruction(UPJO).Method:We retrospectively reviewed the medical records of patients with recurrent UPJO who received robot-assisted pyeloplasty or open pyeloplasty in our hospital.The general information,operative time,intraoperative blood loss,postoperative indwelling time of drainage tube,postoperative hospital stay,postoperative complication rate and treatment outcomes were compared between the two groups.Result:All procedures were performed successfully,and there was no conversion to open surgery in the robot group.There was no significant difference between the two groups in terms of operative time,intraoperative blood loss,postoperative indwelling time of drainage tube or complication rate(P>0.05).Patients in the open group had a significantly longer postoperative hospital stay than that in the robot group(P=0.013).Median follow-up period was 27(range,4-84)months.One patient lost follow-up,and the other 23 patients had improvement in symptoms and degree of hydronephrosis through ultrasound and the intravenous urography determined drainage patency.Conclusion:Compared with open pyeloplasty,robot-assisted pyeloplasty is safe and effective for patients with recurrent UPJO in terms of less injury,quicker postoperative recovery,and shorter postoperative stay.With the increasing popularity of robotic surgery,robot-assisted pyeloplasty will gradually replace open surgery and become a new treatment choice for patients with recurrent UPJO.
引文
1 Piaggio L A,Corbetta J P,Weller S,et al.Comparative,Prospective,Case-Control Study of Open versus Laparoscopic Pyeloplasty in Children with Ureteropelvic Junction Obstruction:Long-term Results[J].Front Pediatr,2017,5:10.
2 Moscardi P R,Barbosa J A,Andrade H S,et al.Reoperative Laparoscopic Ureteropelvic Junction Obstruction Repair in Children:Safety and Efficacy of the Technique[J].J Urol,2017,197(3Pt 1):798-804.
3 Abdel-Karim A M,Fahmy A,Moussa A,et al.Laparoscopic pyeloplasty versus open pyeloplasty for recurrent ureteropelvic junction obstruction in children[J].J Pediatr Urol,2016,12(6):401.e1-401.e6.
4 Khan F,Ahmed K,Lee N,et al.Management of ureteropelvic junction obstruction in adults[J].Nat Rev Urol,2014,11(11):629-638.
5 Hemal A K,Mishra S,Mukharjee S,et al.Robot assisted laparoscopic pyeloplasty in patients of ureteropelvic junction obstruction with previously failed open surgical repair[J].Int J Urol,2008,15(8):744-746.
6 Lindgren B W,Hagerty J,Meyer T,et al.Robot-assisted laparoscopic reoperative repair for failed pyeloplasty in children:a safe and highly effective treatment option[J].J Urol,2012,188(3):932-937.
7 Asensio M,Gander R,Royo G F,et al.Failed pyeloplasty in children:Is robot-assisted laparoscopic reoperative repair feasible?[J].J Pediatr Urol,2015,11(2):69.e1-6.
8 Yong D,Albala D M.Endopyelotomy in the age of laparoscopic and robotic-assisted pyeloplasty[J].Curr Urol Rep,2010,11(2):74-79.
9 Xu N,Chen S H,Xue X Y,et al.Comparison of Retrograde Balloon Dilatation and Laparoscopic Pyeloplasty for Treatment of Ureteropelvic Junction Obstruction:Results of a 2-Year Follow-Up[J].PLoS One,2016,11(3):e0152463.
10 Elabd S A,Elbahnasy A M,Farahat Y A,et al.Minimally-invasive correction of ureteropelvic junction obstruction:do retrograde endo-incision techniques still have a role in the era of laparoscopic pyeloplasty?[J].Ther Adv Urol,2009,1(5):227-234.
11 Tan H J,Ye Z,Roberts W W,et al.Failure after laparoscopic pyeloplasty:prevention and management[J].J Endourol,2011,25(9):1457-1462.
12 Thomas J C,DeMarco R T,Donohoe J M,et al.Management of the failed pyeloplasty:a contemporary review[J].J Urol,2005,174(6):2363-2366.
13 张琦,万里军,祁小龙,等.首次手术失败后再行腹腔镜肾盂成形术的临床研究[J].临床泌尿外科杂志,2014,29(6):488-491.
14 Abraham G P,Siddaiah A T,Ramaswami K,et al.Laparoscopic management of recurrent ureteropelvic junction obstruction following pyeloplasty[J].Urol Ann,2015,7(2):183-187.
15 Chiancone F,Fedelini M,Pucci L,et al.Laparoscopic management of recurrent ureteropelvic junction obstruction following pyeloplasty:a single surgical team experience with 38cases[J].Int Braz J Urol,2017,43(3):512-517.
16 贾卓敏,时京,陈光富,等.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[J].临床泌尿外科杂志,2017,32(2):105-108.
2 Moscardi P R,Barbosa J A,Andrade H S,et al.Reoperative Laparoscopic Ureteropelvic Junction Obstruction Repair in Children:Safety and Efficacy of the Technique[J].J Urol,2017,197(3Pt 1):798-804.
3 Abdel-Karim A M,Fahmy A,Moussa A,et al.Laparoscopic pyeloplasty versus open pyeloplasty for recurrent ureteropelvic junction obstruction in children[J].J Pediatr Urol,2016,12(6):401.e1-401.e6.
4 Khan F,Ahmed K,Lee N,et al.Management of ureteropelvic junction obstruction in adults[J].Nat Rev Urol,2014,11(11):629-638.
5 Hemal A K,Mishra S,Mukharjee S,et al.Robot assisted laparoscopic pyeloplasty in patients of ureteropelvic junction obstruction with previously failed open surgical repair[J].Int J Urol,2008,15(8):744-746.
6 Lindgren B W,Hagerty J,Meyer T,et al.Robot-assisted laparoscopic reoperative repair for failed pyeloplasty in children:a safe and highly effective treatment option[J].J Urol,2012,188(3):932-937.
7 Asensio M,Gander R,Royo G F,et al.Failed pyeloplasty in children:Is robot-assisted laparoscopic reoperative repair feasible?[J].J Pediatr Urol,2015,11(2):69.e1-6.
8 Yong D,Albala D M.Endopyelotomy in the age of laparoscopic and robotic-assisted pyeloplasty[J].Curr Urol Rep,2010,11(2):74-79.
9 Xu N,Chen S H,Xue X Y,et al.Comparison of Retrograde Balloon Dilatation and Laparoscopic Pyeloplasty for Treatment of Ureteropelvic Junction Obstruction:Results of a 2-Year Follow-Up[J].PLoS One,2016,11(3):e0152463.
10 Elabd S A,Elbahnasy A M,Farahat Y A,et al.Minimally-invasive correction of ureteropelvic junction obstruction:do retrograde endo-incision techniques still have a role in the era of laparoscopic pyeloplasty?[J].Ther Adv Urol,2009,1(5):227-234.
11 Tan H J,Ye Z,Roberts W W,et al.Failure after laparoscopic pyeloplasty:prevention and management[J].J Endourol,2011,25(9):1457-1462.
12 Thomas J C,DeMarco R T,Donohoe J M,et al.Management of the failed pyeloplasty:a contemporary review[J].J Urol,2005,174(6):2363-2366.
13 张琦,万里军,祁小龙,等.首次手术失败后再行腹腔镜肾盂成形术的临床研究[J].临床泌尿外科杂志,2014,29(6):488-491.
14 Abraham G P,Siddaiah A T,Ramaswami K,et al.Laparoscopic management of recurrent ureteropelvic junction obstruction following pyeloplasty[J].Urol Ann,2015,7(2):183-187.
15 Chiancone F,Fedelini M,Pucci L,et al.Laparoscopic management of recurrent ureteropelvic junction obstruction following pyeloplasty:a single surgical team experience with 38cases[J].Int Braz J Urol,2017,43(3):512-517.
16 贾卓敏,时京,陈光富,等.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[J].临床泌尿外科杂志,2017,32(2):105-108.