机器人辅助腹腔镜黏膜下隧道法输尿管再植术的临床疗效分析

Clinical efficacy analysis on robot-assisted laparoscopic ureteral replantation with submucosal tunnel approach

目的:介绍黏膜下隧道法机器人辅助腹腔镜治疗1例医源性输尿管下段狭窄患者和1例单侧重复肾重复巨输尿管合并肾积水患者的学习经验和手术疗效。方法:回顾性分析机器人辅助腹腔镜治疗1例膀胱肿瘤电切术后左侧输尿管下段狭窄、左肾积水,患者抗反流输尿管膀胱吻合采用黏膜下隧道包埋法;1例(左侧)原发性梗阻重复肾重复巨输尿管症患者,首先分离巨输尿管前面和两侧面,保留输尿管和腹壁间系膜先不离断,测量输尿管,剪裁,放入F7双J管,缝合成形后再离断系膜,采用黏膜下隧道包埋法与膀胱再吻合。结果:2例患者手术均成功,无中转开放,手术时间分别为165.8min、176.2min,其中机器人定位时间30min;出血量分别为12.4ml、20.8ml;术后引流管拔除时间第1例5d,第2例6d,2例患者均无明显漏尿,术后尿管拔除时间为14d。术后随访6个月,复查CT和彩超显示肾积水明显减轻,未见输尿管吻合口狭窄和输尿管反流。结论:机器人辅助腹腔镜黏膜下隧道法输尿管膀胱再植术治疗复杂的输尿管下段狭窄和复杂的巨输尿管症安全有效。

Objective:To introduce the learning experience and clinical efficacy of submucosal tunnel approach in robotassisted laparoscopic ureteral replantation on treating 1 case of iatrogenic ureteral stenosis and 1 case of unilateral duplication of kidney and megaureter combined with hydronephrosis.Methods:The 2 patients all underwent the robot-assisted laparoscopic surgery.1 case of lower segment stenosis of left ureter with hydronephrosis after resection of bladder tumor and the anti-reflux ureter-bladder anastomosis was performed with submucosal tunnel approach by robot-assisted laparoscopy.The case of primary bladder neck obstruction with unilateral duplication of kidney and megaureter combined with hydronephrosis was given the separation of front and sides of megaureter first,the membrane between ureter and abdomen were preserved.To measure and cut out the ureter,then put it into F7 double J tube for suturing.The ureter-bladder anastomosis was performed with submucosal tunnel approach after suturing and cutting the membrane off.Results:The two operations were all successfully performed.The operation time of the two cases were 165.8 min and 176.2min respectively,including 30min of robot position adjusting.The operative blood loss was12.4ml and 20.8ml respectively.The postoperative retention time of drainage tube were respectively 5d and 6d.No obvious urine leakage was found after operation.The indwelling time of catheter was 14d for the 2 patients.The CT and color ultrasound indicates significant reduction of hydronephrosis after 6-month following up,no ureteral anastomotic stenosis or ureteral reflux were observed.Conclusion:Robot-assisted laparoscopic ureteral replantation with submucosal tunnel approach is safe and effective in treating complex megaureter and lower segment stenosis of ureter.