达芬奇辅助腹腔镜下输尿管部分切除及膀胱翻瓣成形术治疗低危输尿管下段肿瘤的疗效

Efficacy of Da Vinci robot-assisted laparoscopic segmental ureterectomy combined with bladder flap forming in the treatment of low-risk lower ureteral tumors

目的评价达芬奇机器人辅助腹腔镜下输尿管部分切除及膀胱翻瓣成形术治疗早期输尿管下段肿瘤的临床疗效及安全性。方法回顾性分析2014年10月-2020年9月浙江省人民医院泌尿外科收治的12例输尿管下段肿瘤患者资料。所有患者术前均于该院影像学检查提示输尿管占位或输尿管镜下提示输尿管占位,均符合低危输尿管肿瘤诊断;所有患者均采用达芬奇机器人辅助腹腔镜下输尿管部分切除及膀胱翻瓣成形术进行治疗,术中留置DJ管,并采用带蒂大网膜覆盖吻合处,记录术中及术后并发症,并收集患者术后12~24个月的复查资料,包括膀胱镜、泌尿系计算机断层扫描CT、尿脱落细胞学检查、肾功能以及其他检查。结果机器人手术均一次顺利完成,手术用时110~185 min,术中出血量20~60 mL。围手术期内无尿漏、肾绞痛、高热等并发症发生。术后病理提示12例均为尿路上皮癌,肿瘤切除直径为11~19 mm,其中pTa 4例,pT14例,pT24例。患者术后3月返院复查并于门诊手术室拔除DJ管。在术后随访期内,患者无肾积水、急性肾盂肾炎、吻合口狭窄、肾萎缩等发生。12例患者均无肿瘤远处转移发生,仅1例患者于术后17月膀胱内复发,行经尿道膀胱肿瘤电切治疗。结论达芬奇机器人辅助腹腔镜下输尿管部分切除及膀胱翻瓣成形术是治疗低危输尿管下段肿瘤一种安全有效的治疗方法,具有创伤小、恢复快、并发症少等优点。

Objective To evaluate the clinical efficacy and safety of Da Vinci robot-assisted laparoscopic segmental ureter⁃ectomy combined with bladder flap forming in the treatment of low-risk lower ureteral tumors.Methods A retrospective analysis was performed on 12 patients with lower ureteral tumor admitted to the Department of Urology,Zhejiang Provincial People's Hospital during Oct.2014 and Sep.2020.All cases were diagnosed as low-risk ureteral tumor by imaging examination or ure⁃teroscopy before surgery,and treated with Da Vinci robot-assisted laparoscopic segmental ureterectomy combined with bladder flap forming.During surgery,the DJ tube was indwelt and the ureterovesical anastomosis was covered by a pedicled greater omentum.Intraoperative and postoperative complications were recorded.The follow-up data were collected at 12 to 24 months postoperatively,including cystoscopy,urinary CT,exudate cytology,renal function,and other examinations.Results All one-stage surgeries were successful,with no conversion to open surgery.The operation time was 110-185 min,and the intraoperative blood loss was 20-60 mL.No urinary leakage,renal colic,high fever or other complications occurred in the perioperative peri⁃od.Postoperative pathology showed all 12 patients had urothelial carcinoma,with tumor diameter of 11-19 mm,including 4 pTa cases,4 pT1 cases,and 4 pT2 cases.All patients returned to hospital after 3 months for re-examination and the DJ tube was re⁃moved.No postoperative complications such as hydronephritis,acute pyelonephritis,anastomotic stricture or renal atrophy oc⁃curred.No distant metastasis occurred,and 1 patient had bladder recurrence 17 months after surgery and received transurethral resection of bladder tumor.Conclusion Da Vinci robot-assisted laparoscopic segmental ureterectomy combined with bladder flap forming is safe and effective for the treatment of low-risk lower ureteral tumors,which has the advantages of small trauma,quick recovery and few complications.