Indiana University, Indianapolis, IN, USA.
J Urol. 2012 Feb;187(2):522-7. doi: 10.1016/j.juro.2011.09.158. Epub 2011 Dec 15.
We compared laparoscopic and robotic pyeloplasty to identify factors associated with procedural efficacy.
We conducted a retrospective multicenter trial incorporating 865 cases from 15 centers. We collected perioperative data including anatomical and procedural factors. Failure was defined subjectively as pain that was unchanged or worse per medical records after surgery. Radiographic failure was defined as unchanged or worsening drainage on renal scans or worsening hydronephrosis on computerized tomography. Bivariate analyses were performed on all outcomes and multivariate analysis was used to assess factors associated with decreased freedom from secondary procedures.
Of the cases 759 (274 laparoscopic pyeloplasties with a mean followup of 15 months and 465 robotic pyeloplasties with a mean followup of 11 months, p <0.001) had sufficient data. Laparoscopic pyeloplasty, previous endopyelotomy and intraoperative crossing vessels were associated with decreased freedom from secondary procedures on bivariate analysis, with a 2-year freedom from secondary procedures of 87% for laparoscopic pyeloplasty vs 95% for robotic pyeloplasty, 81% vs 93% for patients with vs without previous endopyelotomy and 88% vs 95% for patients with vs without intraoperative crossing vessels, respectively. However, on multivariate analysis only previous endopyelotomy (HR 4.35) and intraoperative crossing vessels (HR 2.73) significantly impacted freedom from secondary procedures.
Laparoscopic and robotic pyeloplasty are highly effective in treating ureteropelvic junction obstruction. There was no difference in their abilities to render the patient free from secondary procedures on multivariate analysis. Previous endopyelotomy and intraoperative crossing vessels reduced freedom from secondary procedures.
我们比较了腹腔镜和机器人肾盂成形术，以确定与手术疗效相关的因素。
我们进行了一项回顾性多中心研究，纳入了来自 15 个中心的 865 例病例。我们收集了围手术期数据，包括解剖学和手术相关因素。失败的定义是根据病历，术后疼痛无变化或加重。影像学失败的定义是肾扫描显示引流无变化或恶化，或计算机断层扫描显示肾积水加重。对所有结果进行了双变量分析，并进行了多变量分析，以评估与降低二次手术成功率相关的因素。
在 759 例（274 例腹腔镜肾盂成形术，平均随访 15 个月，465 例机器人肾盂成形术，平均随访 11 个月，p<0.001）病例中，有足够的数据。腹腔镜肾盂成形术、既往内切开术和术中交叉血管与二次手术成功率降低有关，腹腔镜肾盂成形术 2 年的无二次手术成功率为 87%，机器人肾盂成形术为 95%，有既往内切开术和无既往内切开术患者的无二次手术成功率分别为 81%和 93%，有术中交叉血管和无术中交叉血管患者的无二次手术成功率分别为 88%和 95%。然而，多变量分析显示，只有既往内切开术（HR 4.35）和术中交叉血管（HR 2.73）显著影响无二次手术成功率。
腹腔镜和机器人肾盂成形术治疗肾盂输尿管连接部梗阻的效果非常好。多变量分析显示，它们在使患者免于二次手术方面的能力没有差异。既往内切开术和术中交叉血管会降低无二次手术成功率。
