膀胱癌术后输尿管肠吻合口狭窄的微创治疗:机器人手术的优势和技术要点

Minimally invasive treatment of ureteral-intestinal-anastomotic stenosis after bladder cancer surgery:advantages and technical points of robot-assisted surgery

输尿管肠吻合口狭窄是膀胱癌根治尿流改道术后较为严重且棘手的并发症,目前治疗该并发症的手术方式并未统一,常见的有传统手术、腔内手术及腹腔镜/机器人腹腔镜手术等,传统的手术方法分为开放手术和肾造瘘术。目前腔内手术治疗主要适用于输尿管狭窄长度较短的良性输尿管狭窄患者。研究表明无论经膀胱还是膀胱外,腹腔镜输尿管再植术都安全可行,机器人手术的优势已经日益凸显。本中心近8年来采用机器人辅助腹腔镜下输尿管膀胱再植术(RAUR)治疗该并发症效果良好,本文总结了该术式应遵循的合理步骤。另外,Bricker膀胱术和原位膀胱回肠术后的输尿管再植手术各有其自身的技术要点。

Ureteral-intestinal-anastomotic stenosis is a serious and intractable complication after radical bladder cancer resection.At present,there is no unified surgical method for the treatment of ureteral-intestinal-anastomotic stenosis,and the common ones are traditional surgical methods,endoluminal surgery and laparoscopic/robotic laparoscopic surgery.Traditional management methods are divided into open surgery and nephrostomy.At present,endoluminal surgery is mainly suitable for patients with benign ureteral strictures and short ureteral stricture length.Studies have shown that laparoscopic ureteral reimplantation is safe and feasible for both transbladder and extravesicular surgery,and the advantages of robot-assisted surgery have become increasingly apparent.In the past 8 years,we have been using RAUR technology to treat this disease with good results,and we summarize the reasonable steps that should be followed for this surgery.In addition,ureteral reimplantations after Bricker surgery and ureteral reimplantations after orthotopic ileal neobladder surgery have their own technical points.