机器人辅助经腹腹腔镜与传统经腹腹腔镜肾盂输尿管成形术治疗肾盂输尿管连接部梗阻的临床对照研究

A controlled clinical trial of robot-assisted and laparoscopic pyeloplasty for the treatment of UPJO

目的探讨使用机器人辅助经腹腹腔镜和传统经腹腹腔镜肾盂输尿管成形术治疗肾盂输尿管连接部梗阻的安全性和临床疗效。方法 2014年9月至2016年3月应用机器人辅助经腹腹腔镜肾盂输尿管成形术治疗患者48例(R-LPP组),同期应用传统经腹腹腔镜肾盂输尿管成形术治疗该病患者69例(C-LPP组),并对两组患者的一般临床资料、手术时间、术中失血量、术后住院天数、术后并发症、手术治疗效果等指标进行对比分析。结果两组肾盂输尿管成形术均成功完成,均无中转开放手术患者。R-LPP组患者在手术操作时间、术中失血量、术后住院时间和术后引流管留置时间方面均优于C-LPP组,而在手术前准备时间长于C-LPP组,两者比较差异具有统计学意义(P<0.05)。两组患者在手术时间、术后额外止痛药使用、术后恢复饮食时间、术后尿漏及切口感染发生率等方面比较差异无统计学意义(P>0.05)。术后平均随访时间18(6~32)个月。术后1年时,患侧肾脏平均肾盂扩张分离的前后径(AP)与术前相比,两组均明显减少,且具有统计学差异(P<0.05)。与术前相比,患者术后1年平均血清肌酐及患侧肾脏平均肾小球滤过率两组均有明显改善,差异有统计学意义(P<0.05)。结论两种手术方式治疗UPJO在短期疗效方面均安全、有效,与传统腹腔镜相比,R-LPP创伤小、恢复快、术后短期疗效理想,是一种安全、可靠的治疗肾盂输尿管连接部梗阻的微创术式,临床应用前景广泛。

Objective To compare the safety and clinical efficacy of robot-assisted laparoscopic transperitoneal pyeloplas- ty （R-LPP） and conventional laparoscopic transperitoneal pycloplasty （C-LPP） in the treatment of ureteropelvic junction ob- struction （UPJO）. Methods The medical records of 48 R-LPP cases and 69 C-LPP cases treated during Sep. 2014 and Mar. 2016 were retrospectively analyzed. The general information, operation time, intraoperative blood loss, mean hospital stay, incidence of postoperative complications and efficacy of the 2 groups were compared. Results All operations in both groups were successfully completed. There were no significant differences in the demographic data of patients between the two groups （P〉0. 05）. The operation time, intraoperative blood loss, postoperative hospital stay, and retention time of drainage tube of the R-LPP group were superior to those of the C-LPP group （P〈0.05）, but R-LPP needed longer preparation time （P〈0.05）. There were no significant differences between the two groups in postoperative dosage of additional analgesics, time nee- ded for normal diet and incidence of complications （P〉0.05）. The average follow-up lasted for 18（6~32） months. One year after operation, the average AP decreased in both groups compared with that before operation （P〈0.05）; GFR and Cr were greatly improved （P〈0.05）. Conclusions Compared with C-LPP, R-LPP is less traumatic, with more rapid recovery and more satisfactory short-term efficacy. It is safe and effective for the treatment of UPJO and has a nice prospect.