机器人辅助的腹腔镜与普通腹腔镜下UPJ成型的比较研究

The comparative study between conventional laparoscopic pyeloplasty and robotic-assisted laparoscopic pyeloplasty in management of ureteropelvic junction obstruction

目的:比较机器人辅助腹腔镜和普通腹腔镜肾盂成形术治疗肾盂输尿管连接部(UPJ)狭窄所致肾积水的临床资料,探讨UPJ成型的最佳治疗方案.方法:2012年3月～2012年7月,收治7例UPJ狭窄患者,采用经腹腔途径施行机器人辅助腹腔镜肾盂成形术治疗UPJ狭窄2例;采用经腹腔途径腹腔镜肾盂成形术治疗UPJ狭窄5例.所有手术均由具有熟练腹腔镜UPJ成型手术经验的同一术者完成.结果:7例手术均获成功.其中机器人辅助腹腔镜UPJ成型手术时间90～140 min(剔除平均56 min的机器人准备和摆体位的时间),平均115 min,出血量30～70 ml,术后住院时间都为7 d,术后随访2～3个月,超声提示集合系统分离分别减少至1.5、2.0 cm,腰痛症状均消失.5例行普通腹腔镜UPJ成型患者手术时间90～180min,平均120 min,出血量100～200 ml,术后平均住院8 d,术后随访2～12个月,超声提示集合系统分离减少至平均2.3 cm.结论:机器人辅助腹腔镜UPJ狭窄离断成型术在手术吻合时间和术中出血方面与普通腹腔镜相比具有一定优势,术中缝合步骤得到显著简化,手术效率提高,且缝合效果更为满意,操作更加精确.

Objective:To compare conventional laparoscopic pyeloplasty with robotic-assisted laparoscopic pyeloplasty in managing the ureteropelvic junction obstruction(UPJO).Methods:Between July 2012 and March 2012,we involved 7UPJO patients in this study.5 were performed conventional laparoscopic pyeloplasty,and 2 were performed robotic-assisted laparoscopic pyeloplasty.All cases were performed by the surgeon who has extensive experience in conventional laparoscopic pyeloplasty.Results:All the 7operations were performed successfully.The average suturing time for robotic-assisted laparoscopic pyeloplasty was 19(15-23)min,and 45(39-60)min for conventional laparoscopic pyeloplasty respectively.The average blood loss in these two groups were 50(30-70)ml compared 150(100-200)ml;and the average extubation times were 2days compared 4days.Conclusions:Robotic-assisted laparoscopic pyeloplasty could reduce the suturing time and blood loss and achieves more accurate suture by more flexible operation.