北京大学学报(医学版) ›› 2019, Vol. 51 ›› Issue (4): 610-614. doi: 10.19723/j.issn.1671-167X.2019.04.002

• 获奖工作综述 • 上一篇    下一篇

上尿路微创手术的技术改良

丁光璞1,程嗣达1,方冬1,杨昆霖1,李学松1,(),周辉霞2,张骞1,叶雄俊3,周利群1   

  1. 1. 北京大学第一医院泌尿外科, 北京 100034
    2. 中国人民解放军总医院第七医学中心八一儿童医院泌尿外科, 北京 100700
    3. 北京大学人民医院泌尿外科, 北京 100044
  • 收稿日期:2019-05-10 出版日期:2019-08-18 发布日期:2019-09-03
  • 通讯作者: 李学松 E-mail:pineneedle@sina.com

Review of upper urinary modified minimal invasive surgical technology

Guang-pu DING1,Si-da CHENG1,Dong FANG1,Kun-lin YANG1,Xue-song LI1,(),Hui-xia ZHOU2,Qian ZHANG1,Xiong-jun YE3,Li-qun ZHOU1   

  1. 1.Department of Urology, Peking University First Hospital, Beijing 100034, China
    2. Department of Pediatric Urology, Bayi Children’s Hospital Affiliated to The Seventh Medical Center of Chinese PLA General Hospital, No 5 Nanmencang, Beijing, 100700, China
    3. Department of Urology, Peking University People’s Hospital, Beijing 100044, China
  • Received:2019-05-10 Online:2019-08-18 Published:2019-09-03
  • Contact: Xue-song LI E-mail:pineneedle@sina.com

关键词: 上尿路, 微创手术技术, 输尿管重建

Abstract:

Upper urinary surgery is an important area of urology surgery. Open surgery used to be the gold standard of upper urinary surgery. With the development of medical techniques, minimal invasive surgeries including laparoscopic and robot assisted-laparoscopic surgery have gradually replaced the open surgery. Because of the complexity and diversity of upper urinary diseases, surgeries sometimes are difficult, and minimal invasive surgeries require higher surgical abilities of urologists than open surgeries. In recent years, depending on our surgical experience and international reports, our team from three Chinese medical centers summarizes techniques of upper urinary minimal invasive surgeries. For malignant diseases, such as renal and ureteral carcinomas, it’s important to totally remove the tumor first, and then to avoid the surgical injuries. We summarize surgical experience of retroperitoneal laparoscopic partial nephrectomy for moderately complex renal hilar tumors. Our team modified minimal invasive techniques for some complex tumors, including ring suture technique for renal hilar tumors, internal suspension technique for renal ventral tumors, and combination retroperitoneal laparoscopic surgery with mini-flank incision for complex renal tumors. While for begin diseases, urologists should focus on the resections and surgical injuries at the same time. We have reported the novel technique of laparoscopic aspiration for central renal angiomyolipoma, making the surgery simple and available. For reconstruction surgeries, operations should be based on several principals. We generalize it as “4TB principals”, which include “tension-free”, “water-tight”, “thin suture”, “no touch of the key area” and “protecting the blood supply”. Depending on the localization, length, and etiology of the strictures, different techniques are required. Our team summarize the pyeloplasty, ureteral reimplantation and ileal ureter replacement based on our surgical experience. For infant upper urinary surgeries, our team has made invasive surgeries that can be used in complex diseases, such as duplex kidney. Based on years of surgical techniques, our modified surgeries achieve a better subjective cosmetic result than the traditional surgeries. In the future, the standardized, practical, simple and individual minimal invasive surgical technique will become the main direction in the future researches.

Key words: Upper urinary tract, Minimal invasive surgery, Ureteral reconstruction

中图分类号: 

  • R616.2
[1] Rini BI, Campbell SC, Escudier B . Renal cell carcinoma[J]. Lancet, 2009,373(9669):1119-1132.
[2] Ljungberg B, Bensalah K, Canfield S , et al. EAU guidelines on renal cell carcinoma: 2014 update[J]. Eur Urol, 2015,67(5):913-924.
[3] Winfield HN, Donovan JF, Godet AS , et al. Laparoscopic partial nephrectomy: initial case report for benign disease[J]. J En-dourol, 1993,7(6):521-526.
[4] Ng AM, Shah PH, Kavoussi LR . Laparoscopic partial nephrectomy: a narrative review and comparison with open and robotic partial nephrectomy[J]. J Endourol, 2017,31(10):976-984.
[5] Kutikov A, Uzzo RG. The R . E.N.A.L. nephrometry score: a comprehensive standardized system for quantitating renal tumor size, location and depth[J]. J Urol, 2009,182(3):844-853.
[6] Tobert CM, Kahnoski RJ, Thompson DE , et al. RENAL nephrometry score predicts surgery type independent of individual surgeon’s use of nephron-sparing surgery[J]. Urology, 2012,80(1):157-161.
[7] Xu B, Zhang Q, Jin J . Retroperitoneal laparoscopic partial nephrectomy for moderately complex renal hilar tumors[J]. Urol Int, 2014,92(4):400-406.
[8] Sukumar S, Rogers CG . Robotic partial nephrectomy: surgical technique[J]. BJU Int, 2011,108(6 Pt 2):942-947.
[9] Zhang C, Li X, Yu W , et al. Ring suture technique in retro-peritoneal laparoscopic partial nephrectomy for hilar cancer: a new renorrhaphy technique[J]. J Endourol, 2016,30(4):390-394.
[10] Zhong W, Du Y, Zhang L , et al. The application of internal suspension technique in retroperitoneal laparoscopic partial nephrectomy for renal ventral tumors [J/OL]. Bio Med Res Int, 2017, 2017: 1849649.( 2017-03-29)[2019-04-01]..
[11] 叶雄俊, 刘军 , 阿不都克依木·阿不力米提, 等. 后腹腔镜联合经腰小切口"杂交"手术在复杂肾肿瘤保留肾单位手术中的应用[J]. 北京大学学报(医学版), 2017,49(4):613-616.
[12] Flum AS, Hamoui N, Said MA , et al. Update on the diagnosis and management of renal angiomyolipoma[J]. J Urol, 2016,195(4):834-846.
[13] Nelson CP, Sanda MG . Contemporary diagnosis and management of renal angiomyolipoma[J]. J Urol, 2002,168(4 Pt 1):1315-1325.
[14] Okeke AA, Mitchelmore AE, Keeley FX , et al. A comparison of aspiration and sclerotherapy with laparoscopic. de-roofing in the management of symptomatic simple renal cysts[J]. BJU Int, 2003,92(6):610-613.
[15] Xu B, Zhang Q, Jin J . Laparoscopic aspiration for central renal angiomyolipoma: a novel technique based on single-center initial experience[J]. Urology, 2013,81(2):313-318.
[16] 徐奔, 张喆楠, 罗程 , 等. 后腹腔镜下肿瘤吸除术与肾部分切除术治疗肾血管平滑肌脂肪瘤的安全性与有效性对比[J]. 北京大学学报(医学版), 2018,50(4):700-704.
[17] Rouprêt M, Babjuk M, Compérat E , et al. European guidelines on upper tract urothelial carcinomas: 2013 update[J]. Eur Urol, 2013,63(6):1059-1071.
[18] 刘荣耀, 赵鹏举, 李学松 , 等. 经腹腔完全腹腔镜肾输尿管全长切除术治疗上尿路尿路上皮癌[J]. 北京大学学报(医学版), 2011,43(4):531-534.
[19] Liu P, Fang D, Xiong G , et al. A novel and simple modification for management of distal ureter during laparoscopic nephroureterectomy without patient repositioning: a bulldog clamp technique and description of modified port placement[J]. J Endourol, 2016,30(2):195-200.
[20] Hong P, Cai Y, Li Z , et al. Modified laparoscopic partial ureterectomy for adult ureteral fibroepithelial polyp: technique and initial experience[J]. Urol Int, 2019,102(1):13-19.
[21] O'Reilly PH , Brooman PJ, Mak S, et al. Long-term results of Anderson-Hynes pyeloplasty[J]. BJU Int, 2001,87(4):287-289.
[22] Yang K, Yao L, Li X , et al. Surgical techniques in urology a modified suture technique for transperitoneal laparoscopic dismembered pyeloplasty of pelviureteric junction obstruction[J]. Urology, 2015,85(1):263-267.
[23] Hong P, Ding G, Zhu D , et al. Head-to-head comparison of modified laparoscopic pyeloplasty and Robot-assisted pyeloplasty for ureteropelvic junction obstruction in China[J]. Urol Int, 2018,101(3):337-344.
[24] 杨昆霖, 李学松, 周利群 . 经腹腹腔镜输尿管体外裁剪、乳头再植术治疗成人梗阻性巨输尿管症的方法[J]. 北京大学学报(医学版), 2014,46(4):511-514.
[25] He R, Yu W, Li X , et al. Laparoscopic ureteral reimplantation with extracorporeal tailoring and direct nipple ureteroneocystostomy for adult obstructed megaureter: a novel technique[J]. Urology, 2013,82(5):1171-1174.
[26] Zhong W, Yao L, Cui H , et al. Laparoscopic ureteral reimplantation with extracorporeal tailoring and direct nipple ureteroneocystostomy for adult obstructive megaureter: long-term outcomes and comparison to open procedure[J]. Int Urol Nephrol, 2017,49(11):1973-1978.
[27] Shoemaker GE . Removal of the ureter with a tuberculous kidney[J]. Ann Surg, 1911,53(5):696-698.
[28] Kocot A, Kalogirou C, Vergho D , et al. Long-term results of ileal ureteric replacement: a 25-year single-centre experience[J]. BJU Int, 2017,120(2):273-279.
[29] 陈晓鹏, 汤坚强, 李学松 , 等. 回肠代输尿管术治疗长段输尿管缺损一例报道并文献复习[J]. 中华临床医师杂志:电子版, 2011,5(8):2410-2413.
[30] 钟文龙, 杨昆霖, 李学松 , 等. 回肠代输尿管术治疗双侧长段输尿管损伤一例报告并文献复习[J]. 中华泌尿外科杂志, 2016,37(8):599-602.
[31] Zhong W, Du Y, Yang K , et al. Ileal ureter replacement combined with boari flap-psoas hitch to treat full-length ureteral defects: technique and initial experience[J]. Urology, 2017,108:201-206.
[32] Koyle MA, Woo HH, Kavoussi LR . Laparoscopic nephrectomy in the first year of life[J]. J Pediatr Surg, 1993,28(5):693-695.
[33] Norris RD, Ost MC . Evolution of laparoscopy in pediatric urology[J]. Expert Rev Med Devices, 2009,6(6):689-698.
[34] 周辉霞, 孙宁, 谢华伟 , 等. 经脐单部位三通道腹腔镜治疗小儿上尿路疾病[J]. 中华小儿外科杂志, 2011,32(7):515-518.
[35] Peters CA, Schlussel RN, Retik AB . Pediatric laparoscopic dismembered pyeloplasty[J]. J Urol, 1995,153(6):1962-1965.
[36] Cao H, Zhou H, Liu K , et al. A modified technique of paraum-bilical three-port laparoscopic dismembered pyeloplasty for infants and children[J]. Pediatr Surg Int, 2016,32(11):1037-1045.
[37] Liu D, Zhou H, Ma L , et al. Comparison of laparoscopic approaches for dismembered pyeloplasty in children with ureteropelvic junction obstruction: critical analysis of 11-year experiences in a single surgeon[J]. Urology, 2017,101:50-55.
[38] 王超, 周辉霞, 马立飞 , 等. 小儿经脐单部位腹腔镜肾盂输尿管成形术:单中心80例学习曲线结果分析[J]. 中华小儿外科杂志, 2016,37(3):211-215.
[39] Liu D, Zhou H, Ma L , et al. Transumbilical multi-port laparoscopic pyeloplasty versus transumbilical single-site laparoscopic pyeloplasty for ureteropelvic junction obstruction in children: A retrospectively comparative study [J]. J Pediatr Urol, 2017, 13(6): 618. e1-e5.
[40] Zhou H, Ming S, Ma L , et al. Transumbilical single-incision laparoscopic versus conventional laparoscopic upper pole heminephroureterectomy for children with duplex kidney: a retrospective comparative study[J]. Urology, 2014,84(5):1199-1204.
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