经腹腔机器人辅助与后腹腔镜下离断式肾盂成形术的疗效比较

Comparison of transperitoneal robot assisted and retroperitoneal laparoscopic Anderson-Hynes dismembered pyeloplasty for the treatment of ureteropelvic junction obstruction

目的比较经腹腔机器人辅助与后腹腔镜下离断式肾盂成形术治疗肾盂输尿管连接处梗阻（UPJO）的手术效果。方法2008年9月至2009年6月完成机器人辅助腹腔镜离断式肾盂成形术6例，男5例，女1例，年龄14—40岁，平均25岁，病变位于左右侧各3例。B超检查提示重度肾积水4例，中度肾积水2例。其中4例行IVU检查，3例显影良好。同期经后腹腔下离断式肾盂成形术12例为对照组。两组患者性别、患侧及手术方式、年龄差异均无统计学意义。比较两组手术时间、术中吻合时问、术中出血量、术后引流管、尿管留置时间、术后住院时间及手术成功率。结果两组患者手术均获成功，无中转开放手术者。机器人组与后腹腔镜组的手术时间分别为（157±20）和（127±18）rain，吻合时间（44±6）和（49±6）min，术中出血量（23±8）和（21±17）ml，差异均无统计学意义（P〉0．05）；留置引流管时间（47±10）和（161±41）h，导尿管留置时间（92±46）和（175±26）h，术后住院时间（6．0±0．8）和（8．0±0．5）d，差异均有统计学意义（P〈0．05）。术后随访6—32个月，平均20个月，两组患者症状均消失，肾积水均明显减轻，未见复发。结论经腹腔机器人辅助与后腹腔镜下离断式肾盂成形术相比，两者手术时间、术中吻合时间无明显差异，但前者留置引流管及尿管时间短，术后恢复快，临床疗效无明显差异。

Objective To lcompare the clinical effectiveness and safety of transperitoneal robot assisted and retroperitoneal laparoscopic Anderson-Hynes dismembered pyeloplasty for the treatment of ureteropelvic junction obstruction. Methods From September 2008 to June 2009, six patients with primary UPJO underwent transperitoneal robot assisted dismembered pyeloplasty （TRADP） （5 males and 1 female; average age 25 yrs, range from 14-40 yrs） , of whom 4 with severe hydronephrosis, 2 with intermediate. According to the demographic and preoperative information, each patient in the TRADP group was matched to two corresponding patients with primary UPJO accepting retroperitoneal laparoscopic Anderson-Hynes dismembered pyeloplasty （RLADP） in the same period. The operative time, the intracorporeal suturing time, intraoperative blood loss, the duration of the urethral catheter and the drainage time, the postoperative hospital stay and the postoperative result were compared between the 2 groups. The two groups were identical with regard to gender, side of UPJO, and surgical procedure. The mean age and BMI were comparable between the TRADP and RLADP. Results Between the two groups, the operative time was （ 157 ± 20） min vs （127 ±18） min （P〉0.05）, the intracorporeal suturing time was （44 ：±6） min vs （49 ±6） min （P 〉0.05）. In TRADP and RLADP groups, the intraoperative blood loss was （23 ± 8 ） ml vs （21 ± 17 ） ml （P 〉0.05） , the duration of the drain was （47 ± 10） h vs （161 ±41） h （P 〈0.01） , the duration of the urethral catheter was （92 ± 46） h vs （ 175 ± 26） h （ P 〈 0.05 ）, the postoperative hospital stays were （6.0 ± 0.8） d vs （8.0 ± 0.5 ） d （P 〈 0.01 ）. The operation was successful in all eases of two groups ,with no conversion to open surgery. The follow-up of 6 - 32 months, with average of 20 months, showed that the clinical symptoms in the two groups disappeared and the hydronephrosis relieved. Conclusion Compared with RLADP, the TRADP has the comparable operative time, but the postoperative management for TRADP is more simple and the healing is faster, the postoperative outcomes are comparable as well.