目的:为了研究可行性,机器人辅助腹腔镜颊黏膜移植输尿管成形术治疗复杂的输尿管近端狭窄的安全性和有效性。
方法:分析20例输尿管近端狭窄患者接受机器人辅助腹腔镜颊黏膜移植输尿管成形术的临床资料,对2022年7月至2023年1月北京大学第一医院和北京建工医院进行前瞻性收集和分析。术中情况,记录并分析术后并发症和随访资料.
结果:所有20例患者均成功完成了机器人辅助腹腔镜下的手术,没有转换为传统腹腔镜手术或开腹手术。该研究包括14名男性和6名女性,平均年龄为(41±11)岁(范围:19至60岁),平均体重指数为(24.3±3.6)kg/m2(范围:18.2至31.8kg/m2)。左侧9例,右侧11例。所有患者的狭窄均位于输尿管的近端(包括输尿管肾盂交界处)。术前平均血肌酐(92.2±23.3)μmol/L(范围:49.2~138.9μmol/L),输尿管狭窄的平均长度为(2.8±0.9)cm(范围:1.0至4.0cm)。10例患者以前接受过不成功的重建手术。在操作过程中,12例患者接受了腹侧onlay的向后增强吻合。术中收集的颊粘膜移植物的平均长度为(3.1±0.6)cm(范围:2.0至4.3cm),中位数宽度为1.5厘米(范围:1.0至2.0厘米)。20例均采用网膜瓣包裹重建输尿管段。中位手术时间为154分钟(范围:113至300分钟),估计失血的中位数为45mL(范围:0至100mL)。术后住院时间中位数为4d(4~14d)。术后平均随访时间(15.0±1.7)个月(12.5~17.9个月),手术成功率为100.0%。手术后,11例患者报告口腔供体部位轻度不适,2例患者发生尿路感染,其他7例患者均未报告术后并发症。术后6个月平均血肌酐(90.9±23.9)μmol/L(范围:60.0~153.0μmol/L)。
结论:机器人辅助腹腔镜颊黏膜移植输尿管成形术治疗复杂的输尿管近端长段狭窄疗效满意,无严重并发症。这表明了很好的可行性,安全性和有效性。然而,仍需要大样本研究和长期随访来评估其长期疗效.
OBJECTIVE: To investigate the feasibility, safety and effectiveness of robot-assisted laparoscopic buccal mucosa graft ureteroplasty in the treatment of complex long proximal ureteral stricture.
METHODS: The clinical data of 20 patients with proximal ureteral stricture undergoing robot-assisted laparoscopic buccal mucosa graft ureteroplasty admitted to the Department of Urology, Peking University First Hospital and Beijing Jiangong Hospital from July 2022 to January 2023 were prospectively collected and analyzed. Intraoperative conditions, postoperative complications and follow-up data were also recorded and analyzed.
RESULTS: The operations under robot-assisted laparoscopy were performed successfully in all the 20 patients without conversion to traditional laparoscopic surgery or open surgery. The study included 14 males and 6 females with a mean age of (41±11) years (range: 19 to 60 years) and a mean body mass index of (24.3±3.6) kg/m2 (range: 18.2 to 31.8 kg/m2). There were 9 cases on the left side and 11 cases on the right side. The strictures of all the patients were located in the proximal segment of the ureter (including the ureteropelvic junction). The mean preoperative serum creatinine was (92.2±23.3) μmol/L (range: 49.2 to 138.9 μmol/L), and the mean length of ureteral stricture was (2.8±0.9) cm (range: 1.0 to 4.0 cm). Ten patients had previously undergone unsuccessful reconstructive surgery. During the operation, 12 patients received posteriorly augmented anastomosis with ventral onlay. The mean length of the buccal mucosa graft harvested during the operation was (3.1±0.6) cm (range: 2.0 to 4.3 cm), and the median width was 1.5 cm (range: 1.0 to 2.0 cm). The omentum flap was used to wrap the reconstructed ureteral segment in all the 20 cases. The median operative time was 154 min (range: 113 to 300 min), and the median estimated blood loss was 45 mL (range: 0 to 100 mL). The median postoperative hospital stay was 4 d (range: 4 to 14 d). The mean postoperative follow-up time was (15.0±1.7) months (range: 12.5 to 17.9 months), and the surgical success rate was 100.0% in this study. After surgery, 11 patients reported mild discomfort at the oral donor site, 2 patients deve-loped urinary tract infection, and no postoperative complications were reported in the other 7 patients. The mean serum creatinine was (90.9±23.9) μmol/L (range: 60.0 to 153.0 μmol/L) six months after surgery.
CONCLUSIONS: Robot-assisted laparoscopic buccal mucosa graft ureteroplasty for the treatment of complex long proximal ureteral stricture has satisfactory efficacy without severe complications, which has shown good feasibility, safety and effectiveness. However, large sample studies and long-term follow-up are still needed to evaluate its long-term efficacy.