机器人辅助腹腔镜输尿管再植术治疗小儿输尿管下段狭窄16例

Robot-assisted Laparoscopic Ureteral Reimplantation for Pediatric Primary Obstructive Megaureter:a Retrospective Study of 16 Cases

目的探讨机器人辅助腹腔镜输尿管再植术(robot-assisted laparoscopic ureteral reimplantation,RALUR)的临床疗效。方法2021年1月~2022年9月我科采用RALUR治疗16例小儿输尿管下段狭窄,分离输尿管至末端,切开膀胱逼尿肌至膀胱黏膜膨出,建立膀胱黏膜下隧道包埋输尿管,闭合膀胱黏膜,未留置腹腔内引流管。结果16例RALUR顺利完成,无中转开放手术者。手术时间(132.1±20.5)min。术中出血量5~20 ml,平均10.6 ml。术后血尿时间(4.0±1.2)d,术后导尿管留置时间(3.7±1.4)d。术后住院时间平均8.0 d(7~10 d)。住院费用(60089.4±6304.3)元。术后1个月膀胱镜下拔除双J管。彩超及磁共振泌尿系水成像示患侧输尿管最大径术前(1.80±0.40)cm,明显大于术后6个月(0.70±0.14)cm(t=15.271,P=0.000)。1例发生患侧输尿管Ⅰ度反流,经过保守治疗后反流消失;其余15例无腰痛及尿路感染发生,无再次手术。结论RALUR治疗小儿输尿管狭窄疗效满意,但费用昂贵。

Objective To explore clinical outcomes of robot-assisted laparoscopic ureteral reimplantation(RALUR).Methods Clinical data of 16 children with primary obstructive megaureter(POM)who underwent RALUR from January 2021 to September 2022 were retrospectively analyzed.The ureter was separated to the end,and the detrusor muscle of the bladder was incised to the bulging of the bladder mucosa.A bladder submucosal tunnel was established to embed the ureter,and the bladder mucosa was closed.No intraperitoneal drainage tube was left.Results The RALUR procedure was successfully completed in all the 16 patients without conversion to open surgery.The operating time was(132.1±20.5)min,and the intraoperative blood loss was 5-20 ml(mean,10.6 ml).The duration of postoperative hematuria was(4.0±1.2)d,and the indwelling time of postoperative catheter was(3.7±1.4)d.The duration of postoperative hospitalization was 8.0 d(range,7-10 d).The cost of hospitalization was(60089.4±6304.3)yuan.The double-J stent was extracted in outpatient clinic at 1 month after operation.The color ultrasound and magnetic resonance urography showed that the maximum diameter of the affected ureter was(1.80±0.40)cm before surgery,which was significantly larger than(0.70±0.14)cm at 6 months after surgery(t=15.271,P=0.000).One case experienced first-degree ureteral reflux on the affected side,which disappeared after conservative treatment.The remaining 15 cases had no low back pain or urinary tract infection.There was no case of re-operation.Conclusion The therapeutic effect of RALUR on pediatric POM is satisfactory,but it is expensive.