机器人辅助腹腔镜自体舌黏膜补片输尿管成形术治疗输尿管狭窄的效果分析

The effect of robot-assisted laparoscopic ventral onlay lingual mucosal graft ureteroplasty for ureteral stricture

目的探讨采用机器人辅助腹腔镜自体舌黏膜补片输尿管成形术治疗输尿管狭窄的有效性和安全性。方法回顾性分析2020年12月至2022年8月贵州省人民医院收治的6例输尿管狭窄患者的临床资料。男3例,女3例;年龄(40.2±11.5)岁。术前均行泌尿系B超、CT尿路造影和输尿管逆行造影等检查评估肾积水程度和输尿管狭窄情况。病变位于左侧2例,右侧4例;上段狭窄4例,中段狭窄2例;患侧肾盂分离3.2(2.1,4.2)cm,输尿管狭窄长度为3.8(2.5,4.3)cm(1.0~5.0cm),术前血肌酐90(71,97)μmol/L。所有患者均行机器人辅助腹腔镜自体舌黏膜补片输尿管成形术。术中充分暴露并纵行切开输尿管狭窄段,根据狭窄情况切取长2.5~5.0cm、宽1.0~1.5cm的舌黏膜,修剪后与狭窄段输尿管吻合修复输尿管狭窄。术中均于患侧输尿管内留置双J管1根。分析围手术期结果及并发症情况。比较治疗前后血肌酐和患侧肾孟分离情况。结果6例手术均顺利完成,手术时间(190.8±59.0)min,术中出血量中位值40(20,63)ml,术后术区引流管留置时间6(4,6)d,胃肠道功能恢复时间3(2,3)d,术后住院时间6(6,7)d。所有患者术后1周舌部伤口愈合良好,言语清晰;术后2周拔除尿管;术后拔除双J管时间8(6,10)周。术后第3个月复查肾功能及影像学检查,血肌酐79(71,104)μmol/L,患侧肾盂分离1.2(1.2,1.4)cm,均较术前明显改善。结论机器人辅助腹腔镜自体舌黏膜补片输尿管成形术治疗输尿管狭窄,具有创伤小、术后恢复快、围手术期并发症少等特点,是一种安全、有效的治疗方法。

Objective To investigate the clinical safety and efficacy of robot-assisted laparoscopic ventral onlay lingual mucosal graft ureteroplasty for ureteral stricture.Methods The clinical data of 6 patients with ureteral stricture admitted to the Guizhou Provincial People's Hospital from December 2020 to August 2022 were retrospectively analyzed.There were 3 males and 3 females,with an average age of(40.2±11.5)years old.The status of ureteral stricture and hydronephrosis was measured by ultrasonography,CT urography and ureteral retrograde angiography.There were 2 cases of left ureteral stricture and 4 cases of right ureteral stricture,including 4 cases of upper segment stricture and 2 cases of middle segment stricture.The separation of the renal pelvis on the affected side was 3.2(2.1,4.2)cm.The length of ureteral stricture was 3.8(2.5,4.3)(1.0-5.0)cm,and the preoperative blood creatinine was 90(71,97)μmol/L.Robot-assisted laparoscopic ventral onlay lingual mucosal graft ureteroplasty was performed in all cases under general anesthesia.The strictured ureter segment was separated and longitudinally cut during the operation.The lingual mucosal grafts 2.5-5.0 cm in length and 1.0-1.5 cm in width was cut according to the stricture.Then the lingual mucosal grafts were harvested and placed in the strictured ureter as a ventral onlay.One double J tube was placed in the affected side in all cases during operation.The perioperative outcomes and complications were analyzed.The blood creatinine and renal pelvis separation on the affected side after surgery were compared with the preoperation.Results All the surgeries were successfully completed.The average operative time was(190.8±59.0)min,median blood loss was 40(20,63)ml,postoperative indwelling time of the drainage tube was 6(4,6)days,gastrointestinal function recovery time was 3(2,3)days,postoperative hospital stay was 6(6,7)days.The patients had clear pronunciation and lingual incision recovered 1 week post-operatively.The urine tube was removed 2 weeks after surgery,and the double J tube was removed 8(6,10)weeks post-operatively.Radiological examination revealed significant difference in hydronephrosis on the affected side 3 months post-operatively compared with the preoperation,and the separation of the renal pelvis on the affected side was 1.2(1.2,1.4)cm after surgery.The blood creatinine was 79(71,104)μmol/L at 3 month after surgery,which was also improved compared with preoperative.Conclusions Robot-assisted laparoscopic ventral onlay lingual mucosal graft ureteroplasty is a feasible and safe option for the treatment of ureteral stricture with less trauma,rapid recovery,and less complications.