机器人辅助腹腔镜与传统腹腔镜在腰大肌悬吊输尿管再植术中的应用对比

Application of robotic-assisted versus conventional laparoscopy in ureteral reimplantation with psoas hitch

目的比较机器人辅助腹腔镜与传统腹腔镜完成腰大肌悬吊输尿管再植手术的疗效。方法回顾性分析2013年6月~2014年12月于解放军总医院泌尿外科行微创腰大肌悬吊输尿管再植手术16例患者的治疗经验,其中行机器人辅助腹腔镜治疗的患者为机器人组,共10例,行传统腹腔镜治疗的患者为腹腔镜组,共6例。对比两组患者的临床治疗经验,通过统计学分析总结两种微创手术行腰大肌悬吊输尿管再植手术的适应症、手术技巧和术后疗效。结果两组患者术手术均于腹腔镜下完成,无中转开放。机器人组与腹腔镜组在手术时间(165.50±52.57 min vs 152.50±73.60 min)、平均出血量(81.00±69.35 m L vs46.67±31.41 m L);术后住院天数(7.10±2.08 d vs 8.67±3.14 d);术后尿管平均保留天数(6.75±1.74 d vs 7.50±2.43 d)上均无显著统计学差异。平均随访13.5月,所有患者均无吻合口漏、输尿管膀胱反流、肾盂输尿管积水。结论机器人辅助腹腔镜与传统腹腔镜腰大肌悬吊法输尿管再植术的手术适应症、手术技巧及术后疗效上无明显差别,但前者对于有盆腔手术史、盆腔粘连或二次行再植手术的病人在降低操作难度、增加操作精细度上具有明显的优势。

Objective To compare the efficacy of robotic-assisted laparoscopic and conventional laparoscopic ureteral reimplantation with psoas hitch. Methods We retrospectively analyzed the data of 10 patients undergoing robotic-assisted laparoscopic ureteral reimplantation with psoas hitch and 6 undergoing conventional laparoscopic ureteral reimplantation between June, 2013 and December, 2014 in the General Hospital of PLA. The indications, surgical techniques and outcomes of the two procedures were compared. Results All the patients completed the laparoscopic procedures without conversion to open surgery. Robotic-assisted and conventional laparoscopic procedures were comparable in terms of the mean operation time(165.50±52.57 vs 152.50±73.60 min), mean volume of blood loss(81.00±69.35 vs 46.67±31.41 m L), mean duration of catheter retention(6.75±1.74 vs 7.50±2.43 days), and mean postoperative hospital stay(7.10±2.08 vs 8.67±3.14 days). The patients were followed up for a mean of 13.5 months, during which none of the patients experienced anastomotic leak, vesicoureteral reflux or hydronephrosis. Conclusion There are no significant differences in surgical indications, surgical techniques or postoperative effect between robotic-assisted and conventional laparoscopic procedures of ureteral reimplantation with psoas hitch, but robotic-assisted laparoscopy can reduced the complexity in operation and increase the surgical precision in patients with a history of pelvic surgery, pelvic adhesion or secondary reimplantation.