Department of Urology, University of California-Irvine, Irvine, California, USA.
J Urol. 2011 Jun;185(6):2196-200. doi: 10.1016/j.juro.2011.02.054. Epub 2011 Apr 17.
For the treatment of ureteropelvic junction obstruction laparoscopic dismembered pyeloplasty and open pyeloplasty have similar outcomes. We present our experience with robot assisted laparoscopic dismembered pyeloplasty.
We retrospectively reviewed all adult robot assisted laparoscopic dismembered pyeloplasties performed at our institution between November 2002 and July 2009. Preoperative evaluation included abdominal computerized tomography angiogram to assess for crossing vessels and diuretic renal scan to quantify the degree of obstruction. Followup with diuretic renal scan and a patient pain analog scale was performed 3, 6 and 12 months after surgery. If the study was normal at 12 months, the patient was followed with ultrasound of the kidneys and bladder to look for ureteral jets. Absent ureteral jets, worsening hydronephrosis or patient complaint of pain necessitated repeat diuretic renogram.
A total of 61 robot assisted laparoscopic dismembered pyeloplasties were performed in 21 men and 40 women. Followup was available for 57 patients with an average ± SD age of 35 ± 16 years and average followup of 18 ± 15 months. Mean operative time was 335 ± 88 minutes and estimated blood loss was 61 ± 48 ml. Average hospitalization time was 2 ± 0.9 days and the average postoperative analgesia requirement was 13 ± 9.6 mg morphine sulfate equivalents. The overall success rate was 81% based on a normal diuretic renogram and lack of pain using a validated pain scale. There were 3 grade III Clavien complications for a 4.9% major complication rate.
Robot assisted laparoscopic dismembered pyeloplasty is a feasible technique for ureteropelvic junction reconstruction. When measured by the more stringent application of diuretic renography and analog pain scales, the success rate for ureteropelvic junction obstruction management appears similar to that of open or standard laparoscopic approaches.
对于肾盂输尿管连接部梗阻的治疗，腹腔镜离断肾盂成形术和开放肾盂成形术的效果相似。我们介绍了机器人辅助腹腔镜离断肾盂成形术的经验。
我们回顾性分析了 2002 年 11 月至 2009 年 7 月期间在我院进行的所有成人机器人辅助腹腔镜离断肾盂成形术。术前评估包括腹部计算机断层血管造影术以评估交叉血管，以及利尿剂肾扫描以量化梗阻程度。术后 3、6 和 12 个月进行利尿剂肾扫描和患者疼痛模拟评分随访。如果 12 个月时研究正常，患者将接受肾脏和膀胱超声检查以寻找输尿管喷流。如果没有输尿管喷流、肾积水加重或患者抱怨疼痛，则需要重复进行利尿剂肾扫描。
共对 21 名男性和 40 名女性进行了 61 例机器人辅助腹腔镜离断肾盂成形术。57 例患者可获得随访，平均年龄为 35±16 岁，平均随访时间为 18±15 个月。平均手术时间为 335±88 分钟，估计失血量为 61±48ml。平均住院时间为 2±0.9 天，平均术后镇痛需求为 13±9.6mg 硫酸吗啡当量。根据利尿剂肾扫描正常和使用验证后的疼痛评分无疼痛，总体成功率为 81%。有 3 例 III 级 Clavien 并发症，严重并发症发生率为 4.9%。
机器人辅助腹腔镜离断肾盂成形术是肾盂输尿管连接部重建的可行技术。当用更严格的利尿剂肾扫描和模拟疼痛评分来衡量时，肾盂输尿管连接部梗阻管理的成功率似乎与开放或标准腹腔镜方法相似。
