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北京大学学报（医学版） ›› 2024, Vol. 56 ›› Issue (4): 640-645. doi: 10.19723/j.issn.1671-167X.2024.04.016

• 论著 • 上一篇    下一篇

机器人辅助腹腔镜下颊黏膜补片输尿管成形术治疗复杂输尿管狭窄

应沂岑1,杜毅聪1,李志华1,张一鸣1,李新飞1,王冰2,张鹏3,朱宏建4,周利群1,杨昆霖1,*(),李学松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, 国家泌尿男生殖系肿瘤中心, 北京 100034
    2. 北京大学第一医院密云区医院泌尿外科, 北京 101599
    3. 应急总医院泌尿外科, 北京 100028
    4. 北京市健宫医院泌尿外科, 北京 100054
  • 收稿日期:2024-03-16 出版日期:2024-08-18 发布日期:2024-07-23
  • 通讯作者: 杨昆霖,李学松 E-mail:yangkunlin12345@163.com;pineneedle@sina.com
  • 基金资助:
    中央高水平医院临床科研业务费-北京大学第一医院青年临床研究专项(2023YC16)

Robot-assisted laparoscopic ureteroplasty with buccal mucosa graft for complex ureteral stricture

Yicen YING1,Yicong DU1,Zhihua LI1,Yiming ZHANG1,Xinfei LI1,Bing WANG2,Peng ZHANG3,Hongjian ZHU4,Liqun ZHOU1,Kunlin YANG1,*(),Xuesong LI1,*()   

  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, Miyun Hospital, Peking University First Hospital, Beijing 101599, China
    3. Department of Urology, Emergency General Hospital, Beijing 100028, China
    4. Department of Urology, Beijing Jiangong Hospital, Beijing 100054, China
  • Received:2024-03-16 Online:2024-08-18 Published:2024-07-23
  • Contact: Kunlin YANG,Xuesong LI E-mail:yangkunlin12345@163.com;pineneedle@sina.com
  • Supported by:
    the National High Level Hospital Clinical Research Funding-Youth Clinical Research Project of Peking University First Hospital(2023YC16)

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摘要：

目的: 探讨机器人辅助腹腔镜下颊黏膜补片输尿管成形术治疗复杂输尿管上段、长段狭窄的可行性、安全性及有效性。方法: 收集2022年7月至2023年1月于北京大学第一医院泌尿外科和北京市健宫医院泌尿外科收治的20例行机器人辅助腹腔镜下颊黏膜补片输尿管成形术治疗输尿管上段狭窄患者的临床资料，记录并分析术中情况、术后并发症及随访资料。结果: 本研究包含14例男性和6例女性，平均年龄(41±11)岁(范围19~60岁)，平均体重指数(24.3±3.6) kg/m2 (范围18.2~31.8 kg/m2)。左侧9例，右侧11例，所有患者的狭窄部位均位于输尿管上段(包含肾盂-输尿管连接部)。平均术前血肌酐(92.2±23.3) μmol/L (范围49.2~138.9 μmol/L)，平均输尿管狭窄长度为(2.8±0.9) cm (范围1.0~4.0 cm)。20例患者中10例患者既往接受过失败的重建手术，12例患者术中接受了输尿管后壁加强吻合。平均获取颊黏膜补片长度为(3.1±0.6) cm (范围2.0~4.3 cm)，中位宽度为1.5 cm (范围1.0~2.0 cm)。中位手术时长154 min (范围113~300 min)，中位术中估计出血量45 mL (范围0~100 mL)。中位术后住院日为4 d (范围4~14 d)。平均术后随访时间(15.0±1.7) 月(范围12.5~17.9月)，手术成功率为100.0%。术后11例患者报告了颊黏膜取材部位的轻度不适，2例患者术后出现泌尿系感染，其他7例没有报告术后并发症。术后6个月复查血肌酐，为(90.9±23.9) μmol/L (范围60.0~153.0 μmol/L)。结论: 机器人辅助腹腔镜下颊黏膜补片输尿管成形术治疗复杂输尿管上段、长段狭窄疗效满意，无严重并发症发生，具有较好的可行性、安全性和有效性，但需大样本研究及长时间随访评估其远期疗效。

关键词: 机器人手术, 输尿管狭窄, 颊黏膜, 修复外科手术

Abstract:

Objective: To investigate the feasibility, safety and effectiveness of robot-assisted laparoscopic buccal mucosa graft ureteroplasty in the treatment of complex long proximal ureteral stricture. Methods: The clinical data of 20 patients with proximal ureteral stricture undergoing robot-assisted laparoscopic buccal mucosa graft ureteroplasty admitted to the Department of Urology, Peking University First Hospital and Beijing Jiangong Hospital from July 2022 to January 2023 were prospectively collected and analyzed. Intraoperative conditions, postoperative complications and follow-up data were also recorded and analyzed. Results: The operations under robot-assisted laparoscopy were performed successfully in all the 20 patients without conversion to traditional laparoscopic surgery or open surgery. The study included 14 males and 6 females with a mean age of (41±11) years (range: 19 to 60 years) and a mean body mass index of (24.3±3.6) kg/m2 (range: 18.2 to 31.8 kg/m2). There were 9 cases on the left side and 11 cases on the right side. The strictures of all the patients were located in the proximal segment of the ureter (including the ureteropelvic junction). The mean preoperative serum creatinine was (92.2±23.3) μmol/L (range: 49.2 to 138.9 μmol/L), and the mean length of ureteral stricture was (2.8±0.9) cm (range: 1.0 to 4.0 cm). Ten patients had previously undergone unsuccessful reconstructive surgery. During the operation, 12 patients received posteriorly augmented anastomosis with ventral onlay. The mean length of the buccal mucosa graft harvested during the operation was (3.1±0.6) cm (range: 2.0 to 4.3 cm), and the median width was 1.5 cm (range: 1.0 to 2.0 cm). The omentum flap was used to wrap the reconstructed ureteral segment in all the 20 cases. The median operative time was 154 min (range: 113 to 300 min), and the median estimated blood loss was 45 mL (range: 0 to 100 mL). The median postoperative hospital stay was 4 d (range: 4 to 14 d). The mean postoperative follow-up time was (15.0±1.7) months (range: 12.5 to 17.9 months), and the surgical success rate was 100.0% in this study. After surgery, 11 patients reported mild discomfort at the oral donor site, 2 patients deve-loped urinary tract infection, and no postoperative complications were reported in the other 7 patients. The mean serum creatinine was (90.9±23.9) μmol/L (range: 60.0 to 153.0 μmol/L) six months after surgery. Conclusion: Robot-assisted laparoscopic buccal mucosa graft ureteroplasty for the treatment of complex long proximal ureteral stricture has satisfactory efficacy without severe complications, which has shown good feasibility, safety and effectiveness. However, large sample studies and long-term follow-up are still needed to evaluate its long-term efficacy.

Key words: Robotic surgical procedures, Ureteral stricture, Buccal mucosa, Reconstructive surgical procedures

中图分类号: 

  • R693.2

图1

机器人辅助颊黏膜补片输尿管成形术"

图2

机器人辅助颊黏膜补片输尿管成形术手术前后造影及术后输尿管镜检查"

1 Li X , Qiao J , Xiong S , et al. The surgical outcomes of reconstruction for the treatment of ureteral stricture after holmium laser lithotripsy: The comprehensive experiences[J]. Asian J Surg, 2022, 45 (12): 2713- 2718.
doi: 10.1016/j.asjsur.2022.03.018
2 Elbers JR , Rodríguez Socarrás M , Rivas JG , et al. Robotic repair of ureteral strictures: Techniques and review[J]. Curr Urol Rep, 2021, 22 (8): 39.
doi: 10.1007/s11934-021-01056-8
3 Knight RB , Hudak SJ , Morey AF . Strategies for open reconstruction of upper ureteral strictures[J]. Urol Clin North Am, 2013, 40 (3): 351- 361.
doi: 10.1016/j.ucl.2013.04.005
4 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.
doi: 10.1111/bju.13825
5 Monn MF , Roth JD , Bihrle R , et al. Long term outcomes in the use of ileal ureter for radiation-induced ureteral strictures[J]. Int Urol Nephrol, 2018, 50 (8): 1375- 1380.
doi: 10.1007/s11255-018-1904-z
6 Roth JD , Monn MF , Szymanski KM , et al. Ureteral reconstruction with ileum: Long-term follow-up of renal function[J]. Urology, 2017, 104, 225- 229.
doi: 10.1016/j.urology.2017.02.026
7 Eisenberg ML , Lee KL , Zumrutbas AE , et al. Long-term outcomes and late complications of laparoscopic nephrectomy with renal autotransplantation[J]. J Urol, 2008, 179 (1): 240- 243.
doi: 10.1016/j.juro.2007.08.135
8 Tran G , Ramaswamy K , Chi T , et al. Laparoscopic nephrectomy with autotransplantation: Safety, efficacy and long-term durability[J]. J Urol, 2015, 194 (3): 738- 743.
doi: 10.1016/j.juro.2015.03.089
9 Yang K , Fan S , Wang J , et al. Robotic-assisted lingual mucosal graft ureteroplasty for the repair of complex ureteral strictures: Technique description and the medium-term outcome[J]. Eur Urol, 2022, 81 (5): 533- 540.
doi: 10.1016/j.eururo.2022.01.007
10 Lee Z , Lee M , Koster H , et al. A multi-institutional experience with robotic ureteroplasty with buccal mucosa graft: An updated analysis of intermediate-term outcomes[J]. Urology, 2021, 147, 306- 310.
doi: 10.1016/j.urology.2020.08.003
11 Liang C , Wang J , Hai B , et al. Lingual mucosal graft ureteroplasty for long proximal ureteral stricture: 6 years of experience with 41 cases[J]. Eur Urol, 2022, 82 (2): 193- 200.
doi: 10.1016/j.eururo.2022.05.006
12 Wang J , Li Z , Fan S , et al. Robotic ureteroplasty with appendiceal onlay flap: An update on the outcomes of 18-month follow-up[J]. Transl Androl Urol, 2022, 11 (1): 20- 29.
doi: 10.21037/tau-21-840
13 Sterling J , Daneshvar M , Nikolavsky D . Transurethral ventral inlay buccal mucosa graft urethroplasty: Technique and intermediate outcomes[J]. BJU Int, 2023, 132 (1): 109- 111.
doi: 10.1111/bju.16007
14 Lumen N , Vierstraete-Verlinde S , Oosterlinck W , et al. Buccal versus lingual mucosa graft in anterior urethroplasty: A prospective comparison of surgical outcome and donor site morbidity[J]. J Urol, 2016, 195 (1): 112- 117.
doi: 10.1016/j.juro.2015.07.098
15 Naude JH . Buccal mucosal grafts in the treatment of ureteric lesions[J]. BJU Int, 1999, 83 (7): 751- 754.
doi: 10.1046/j.1464-410x.1999.00019.x
16 Kroepfl D , Loewen H , Klevecka V , et al. Treatment of long ureteric strictures with buccal mucosal grafts[J]. BJU Int, 2010, 105 (10): 1452- 1455.
doi: 10.1111/j.1464-410X.2009.08994.x
17 Pandey A , Dican R , Beier J , et al. Buccal mucosal graft in reconstructive urology: Uses beyond urethral stricture[J]. Int J Urol, 2014, 21 (7): 732- 734.
doi: 10.1111/iju.12403
18 Zhao LC , Yamaguchi Y , Bryk DJ , et al. Robot-assisted ureteral reconstruction using buccal mucosa[J]. Urology, 2015, 86 (3): 634- 638.
doi: 10.1016/j.urology.2015.06.006
19 Zhao LC , Weinberg AC , Lee Z , et al. Robotic ureteral reconstruction using buccal mucosa grafts: A multi-institutional experience[J]. Eur Urol, 2018, 73 (3): 419- 426.
doi: 10.1016/j.eururo.2017.11.015
20 Hefermehl LJ , Tritschler S , Kretschmer A , et al. Open ureteroplasty with buccal mucosa graft for long proximal strictures: A good option for a rare problem[J]. Investig Clin Urol, 2020, 61 (3): 316- 322.
doi: 10.4111/icu.2020.61.3.316
21 Cheng S , Fan S , Wang J , et al. Laparoscopic and robotic ureteroplasty using onlay flap or graft for the management of long proximal or middle ureteral strictures: Our experience and strategy[J]. Int Urol Nephrol, 2021, 53 (3): 479- 488.
doi: 10.1007/s11255-020-02679-5
22 葛光炬, 李恭会, 朱世斌, 等. 颊黏膜替代法在机器人辅助输尿管上段狭窄手术中的应用[J]. 中华泌尿外科杂志, 2018, 39 (6): 433- 436.
23 Barbagli G , Vallasciani S , Romano G , et al. Morbidity of oral mucosa graft harvesting from a single cheek[J]. Eur Urol, 2010, 58 (1): 33- 41.
doi: 10.1016/j.eururo.2010.01.012
24 Wang A , Chua M , Talla V , et al. Lingual versus buccal mucosal graft for augmentation urethroplasty: A meta-analysis of surgical outcomes and patient-reported donor site morbidity[J]. Int Urol Nephrol, 2021, 53 (5): 907- 918.
doi: 10.1007/s11255-020-02720-7
25 Maarouf AM , Elsayed ER , Ragab A , et al. Buccal versus lingual mucosal graft urethroplasty for complex hypospadias repair[J]. J Pediatr Urol, 2013, 9 (6 Pt A): 754- 758.
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ISSN 1671-167X
CN 11-4691/R
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