北京大学学报(医学版) ›› 2020, Vol. 52 ›› Issue (4): 771-779. doi: 10.19723/j.issn.1671-167X.2020.04.032

• 技术方法 • 上一篇    下一篇

机器人辅助腹腔镜上尿路修复手术:单一术者108例经验总结

程嗣达1,李新飞1,熊盛炜1,樊书菠1,王杰1,朱伟杰1,李子奡1,丁光璞1,俞婷2,李万强3,孙永明4,杨昆霖1,张雷1,郝瀚1,(),李学松1,(),周利群1   

  1. 1.北京大学第一医院泌尿外科,北京大学泌尿外科研究所,国家泌尿、男性生殖系肿瘤研究中心,北京 100034
    2.三明市第二医院泌尿外科,福建三明 366000
    3.三峡大学第一临床医学院/宜昌市中心人民医院泌尿外科,湖北宜昌 443003
    4.南京鼓楼医院集团宿迁市人民医院泌尿外科,江苏宿迁 223800
  • 收稿日期:2020-04-20 出版日期:2020-08-18 发布日期:2020-08-06
  • 通讯作者: 郝瀚,李学松 E-mail:haohan1122@vip.sina.com;pineneedle@sina.com

Robot-assisted laparoscopic upper urinary tract reconstruction surgery: A review of 108 cases by a single surgeon

Si-da CHENG1,Xin-fei LI1,Sheng-wei XIONG1,Shu-bo FAN1,Jie WANG1,Wei-jie ZHU1,Zi-ao LI1,Guang-pu DING1,Ting YU2,Wan-qiang LI3,Yong-ming SUN4,Kun-lin YANG1,Lei ZHANG1,Han HAO1,(),Xue-song LI1,(),Li-qun ZHOU1   

  1. 1. Department of Urology, Peking University First Hospital; Institute of Urology, Peking University; National Urological Cancer Center, Beijing 100034, China
    2. Department of Urology, The Second Hospital of Sanming, Sanming 366000, Fujian, China
    3. Department of Urology, The First College of Clinical Medical Science, Three Gorges University/Yichang Central People’s Hospital, Yichang 443003, Hubei, China
    4. Department of Urology, Suqian People’s Hospital of Nanjing Drum Tower Hospital Group, Suqian 223800, Jiangsu, China
  • Received:2020-04-20 Online:2020-08-18 Published:2020-08-06
  • Contact: Han HAO,Xue-song LI E-mail:haohan1122@vip.sina.com;pineneedle@sina.com

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),中位术后住院时间7 d(5~26 d),手术成功率为85.7%。结论: 本研究中单一术者应用机器人辅助腹腔镜开展并改良了多种复杂上尿路修复手术术式,对进一步形成标准化、程序化上尿路修复手术方式提供了参考。

关键词: 机器人手术, 腹腔镜, 上尿路, 修复外科手术

Abstract:

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 min), median blood loss was 20 mL (range: 10-50 mL) and median hospital stay was 7 d (range: 5-10 d) in UR group, with the success rate of 90.9%. The median operative time was 166 min (range: 137-205 min), median blood loss was 45 mL (range: 20-100 mL) and median hospital stay was 5 d (range: 4-41 d) in BPS group, with the success rate of 83.3%. The median operative time was 270 min (range: 227-335 min), median blood loss was 100 mL (range: 10-100 mL) and median hospital stay was 7 d (range: 5-26 d) in IUR group, with the success rate of 85.7%. Conclusion: The surgeon performed and modified numerous complicated upper urinary tract reconstruction surgeries by the robotic platform, which facilitated the development of the standardized upper urinary tract reconstruction surgical technique.

Key words: Robotic surgical procedures, Laparoscopy, Upper urinary tract, Reconstructive surgical procedures

中图分类号: 

  • R693.2

图1

肾盂瓣成形术(A~D)、舌黏膜补片修补术(E~H)及阑尾补片修补术(I~L)关键手术步骤"

图2

膀胱悬吊翻瓣术关键手术步骤(A~F)及大网膜包裹技术应用(G~I)"

表1

患者临床资料"

Items MDP (n=53) SFP (n=11) UUT (n=11) LMU (n=5)
Age/years, median (range) 30 (15-64) 29 (19-42) 35 (17-54) 37 (25-45)
Gender (Male/Female), n 30/23 7/4 6/5 3/2
Surgical side (Left/Right), n 24/29 7/4 6/5 5/0
Preoperative eGFR/[mL/(min·1.73 m2)],
median (range)
104.5
(59.7-130.5)
118.3
(84.1-136.0)
104.6
(60.8-118.0)
79.0
(61.0-128.0)
Preoperative degree of hydronephrosis
(Mild/Moderate/Severe/Nephrostomy or DJ stent), n
12/16/18/7 1/2/6/2 1/1/4/5 0/0/0/5
Items AU (n=4) UR (n=11) BP (n=6) IUR (n=7)
Age/years, median (range) 38 (36-41) 38 (18-65) 52.5 (29-67) 48 (30-53)
Gender (Male/Female), n 3/1 2/9 0/6 5/2
Surgical side (Left/Right), n 0/4 5/6 1/5 3/4
Preoperative eGFR/[mL/(min·1.73 m2)],
median (range)
100.6
(90.6-103.0)
99.3
(63.1-112.8)
77.1
(64.6-109.0)
74.6
(59.0-117.0)
Preoperative degree of hydronephrosis
(Mild/Moderate/Severe/Nephrostomy or DJ stent), n
0/0/0/4 5/3/1/2 2/1/1/2 1/1/0/5

表2

不同重建手术的围术期数据及随访数据"

Items MDP (n=53) SFP (n=11) UUT (n=11) LMU (n=5)
Overall operative time/min, median (range) 141 (74-368) 159 (110-222) 126 (76-160) 204 (154-250)
Estimated blood loss/mL, median (range) 20 (10-350) 50 (20-150) 20 (10-50) 30 (10-100)
Hospital stay/d, median (range) 4 (3-19) 5 (3-8) 5 (4-9) 6 (4-7)
Follow-up time/months, median (range) 8 (3-17) 7 (4-13) 7 (3-15) 7 (4-9)
Postoperative eGFR/[mL/(min·1.73 m2)],
median (range)
105.1
(58.3-139.6)
118.5
(89.8-130.2)
105.8
(59.2-125.3)
71.6
(66.7-121.4)
Postoperative degree of hydronephrosis
(None or Mild/Moderate/Severe), n
48/4/1 9/2/0 9/2/0 5/0/0
Overall success rate/% 94.3 100.0 100.0 100.0
Items AU (n=4) UR (n=11) BP (n=6) IUR (n=7)
Overall operative time/min, median (range) 164 (135-211) 149 (100-218) 166 (137-205) 270 (227-335)
Estimated blood loss/mL, median (range) 75 (50-200) 20 (10-50) 45 (20-100) 100 (10-100)
Hospital stay/d, median (range) 8.5 (6-12) 7 (5-10) 5 (4-41) 7 (5-26)
Follow-up time/months, median (range) 8 (4-10) 5 (3-17) 10 (6-12) 9 (5-12)
Postoperative eGFR/[mL/(min·1.73 m2)],
median (range)
105.8
(92.1-115.0)
101.8
(79.7-114.7)
87.4
(63.8-104.1)
77.1
(47.6-115.4)
Postoperative degree of hydronephrosis
(None or Mild/Moderate/Severe), n
4/0/0 11/0/0 6/0/0 6/0/1
Overall success rate/% 100.0 90.7 83.3 85.7
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