腹腔镜和机器人辅助回肠代输尿管术在临床应用中的可行性和治疗效果（英文）

Application of Laparoscopic and Robotic Ileal Uureteral Replacement Feasibility and Clinical Efficacy

回肠代输尿管术是治疗患者长段输尿管狭窄的恰当方式.微创手术技术已被证明和开放手术具有相同的安全性,且在减少手术创伤、出血和术后康复周期方面明显优于开放手术.为了研究腹腔镜下回肠代输尿管术的可行性和临床疗效,对相关文献中该手术方案的手术指征、禁忌症、手术方法和术后结果进行了综述,并结合昆明医科大学第二附属医院对该手术的实践经验进行综合分析.共有20例腹腔镜下回肠代输尿管术报道纳入综述,其手术时间在195～480 min之间,出血量在50～375 mL之间;共有7例机器人辅助的回肠代输尿管术报道纳入综述,其手术时长在320～720 min之间,出血量少于10～100 mL.该手术的并发症包括腹腔内尿瘘、小肠梗阻、吻合口瘘、暂时性氮质血症和泌尿系感染等.术后所有患者的肾功能都得到不同程度恢复.综上,腹腔镜或机器人辅助回肠代输尿管术是治疗长段输尿管狭窄的一种可行且有效的手术方案,尽管其疗效和传统开放手术相当,但腹腔镜和机器人辅助方法因其微创特点仍具有相对优势,它们均可有效降低手术创伤、术中出血量、术后并发症、手术瘢痕形成和术后康复时间.由于现有报道的病例数量有限,故还需对回肠代输尿管的微创手术方案进行更多和长期的研究,以便建立和完善该术式的标准手术步骤和手术技巧.

Ileal ureter is a suitable treatment option for patients with long ureteric strictures.Minimally invasive techniques have been shown to be as safe as open techniques but superior in terms of lesser trauma,less bleeding and less postoperative recovery time.In order to evaluate the feasibility and clinical efficacy of laparoscopic ileal ureter replacement,review of related literatures,indications,contraindications,surgical method,postoperative results combined with experience of our center has been done.Total 20 cases of laparoscopic ileal ureteral operation have been reviewed,the mean operation time was 195~480 and blood loss was 50~375ml and 7 Robotic ileal ureter replacement were reviewed median surgery time was 320~720 min and bleeding is less then 10ml^100 ml.The operation complications include urinary leakage,intestinal obstruction,anastomotic site leakage,transient azotemia,urinary tract infection and so on.Postoperative renal function of all patients was improved in different degrees.Laparoscopic and Robotic ileal ureter replacement is feasible and can be used as an effective treatment for long ureteral injuries,although the curative effect is same as that of traditional open surgery,but Comparatively laparoscopic and robotic postoperative morbidity is less and have advantages such as it reduces surgical trauma,intraoperative bleeding,postoperative complications,less surgical scar and recovery time.The cases in the reports are limited,more cases need to be studied,and long-term results need to be assessed to establish and standardize these technique.