机器人辅助腹腔镜再次手术修复儿童失败的肾盂成形术：一种安全且高效的治疗选择。
Robot-assisted laparoscopic reoperative repair for failed pyeloplasty in children: a safe and highly effective treatment option.
机构信息
Division of Urology, Lurie Children's Hospital, Chicago, Illinois, USA.
出版信息
J Urol. 2012 Sep;188(3):932-7. doi: 10.1016/j.juro.2012.04.118. Epub 2012 Jul 20.
PURPOSE
Failed pyeloplasty represents a management dilemma, with treatment options including balloon dilation, endopyelotomy and reoperative pyeloplasty. We review our experience with robot-assisted laparoscopic reoperative repair of recurrent/persistent ureteropelvic junction obstruction in children and compare this method to other approaches.
MATERIALS AND METHODS
We reviewed in detail all cases of failed prior ureteropelvic junction procedures, either open or laparoscopic, managed by robot-assisted laparoscopic reoperative repair between 2006 and July 2011.
RESULTS
Robot-assisted laparoscopic repair was performed in 16 cases for persistent or recurrent ureteropelvic junction obstruction following a prior procedure involving the ureteropelvic junction (12 open pyeloplasties, 4 robot-assisted laparoscopic repairs). Additional interventions had been performed in 12 patients. Reoperative robot-assisted laparoscopic pyeloplasty was performed in 13 patients and reoperative robot-assisted laparoscopic ureterocalycostomy in 3. Patient age ranged from 12 months to 15.3 years (mean 6.1 years). Mean operative time and length of stay were 303 minutes and 1.6 days, respectively. Mean followup was 14.9 months. All symptomatic patients had resolution of symptoms postoperatively. A total of 14 patients (88%) had improved radiological findings. One patient underwent transfusion and conversion to an open procedure due to bleeding.
CONCLUSIONS
Robot-assisted laparoscopic reoperative repair of persistent/recurrent ureteropelvic junction obstruction is a safe, highly effective procedure even in the setting of multiple prior procedures. In our series all patients improved symptomatically, 88% improved radiographically and none have required further surgical intervention. Success is greater than with endopyelotomy and comparable to open reoperative repair for this challenging condition during short-term and intermediate followup.
目的
肾盂成形术失败是一个治疗难题，其治疗方法包括球囊扩张、内切开术和再次肾盂成形术。我们回顾了机器人辅助腹腔镜治疗儿童复发性/持续性肾盂输尿管连接部梗阻的经验，并将该方法与其他方法进行了比较。
材料和方法
我们详细回顾了 2006 年至 2011 年 7 月期间，因肾盂输尿管连接部手术（12 例开放肾盂成形术，4 例机器人辅助腹腔镜修复术）失败而接受机器人辅助腹腔镜再次手术修复的所有病例。
结果
16 例患者因先前的肾盂输尿管连接部手术（12 例开放肾盂成形术，4 例机器人辅助腹腔镜修复术）后持续性或复发性肾盂输尿管连接部梗阻而接受了机器人辅助腹腔镜修复手术。12 例患者还接受了额外的手术。13 例患者行再次机器人辅助腹腔镜肾盂成形术，3 例行再次机器人辅助腹腔镜输尿管肾盂成形术。患者年龄为 12 个月至 15.3 岁（平均 6.1 岁）。手术时间和住院时间分别为 303 分钟和 1.6 天。平均随访时间为 14.9 个月。所有有症状的患者术后症状均得到缓解。14 例（88%）患者的影像学检查结果得到改善。1 例患者因出血行输血并转为开放手术。
结论
即使在多次手术的情况下，机器人辅助腹腔镜再次手术治疗持续性/复发性肾盂输尿管连接部梗阻也是一种安全、高效的方法。在我们的系列研究中，所有患者症状均得到改善，88%的患者影像学检查结果得到改善，无患者需要进一步手术干预。在短期和中期随访中，该方法的成功率高于内切开术，与开放再次手术治疗该疾病的成功率相当。
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