Fu Weijun, Zhang Xu, Zhang Xiaoyi, Zhang Peng, Gao Jiangping, Dong Jun, Chen Guangfu, Xu Axiang, Ma Xin, Li Hongzhao, Shi Lixin
Department of Urology, PLA General Hospital/Medical school, Beijing, China.
Department of Urology, The Second Artillery General Hospital of PLA, Beijing, China.
PLoS One. 2014 Jun 12;9(6):e99777. doi: 10.1371/journal.pone.0099777. eCollection 2014.
To report our experience of pure laparoscopic and robot-assisted laparoscopic reconstructive surgery in congenital megaureter, seven patients (one bilateral) with symptomatic congenital megaureter underwent pure laparoscopic or robot-assisted laparoscopic surgery. The megaureter was exposed at the level of the blood vessel and was isolated to the bladder narrow area. Extreme ureter trim and submucosal tunnel encapsulation or papillary implantations and anti-reflux ureter bladder anastomosis were performed intraperitoneally by pure laparoscopic or robot-assisted laparoscopic surgery. The clinical data of seven patients after operation were analyzed, including the operation time, intraoperative complications, intraoperative bleeding volumes, postoperative complications, postoperative hospitalization time and pathological results. All of the patients were followed. The operation was successfully performed in seven patients. The mean operation times for pure laparoscopic surgery and robotic-assistant laparoscopic surgery were 175 (range: 150-220) and 187 (range: 170-205) min, respectively, and the mean operative blood loss volumes were 20 (range: 10-30) and 28.75 (range: 15-20) ml, respectively. There were no intraoperative complications. The postoperative drainage time was 5 (range: 4-6) and 5.75 (range: 5-6) d, respectively, and the indwelling catheter time was 6.33 (range: 4-8) d and 7 (range: 7-7) d, respectively. The postoperative hospitalization time was 7.67 (range: 7-8) d and 8 (range: 7-10) d, respectively. There was no obvious pain, no secondary bleeding and no urine leakage after the operation. Postoperative pathology reports revealed chronic urothelial mucosa inflammation. The follow-up results confirmed that all patients were relieved of their symptoms. Both pure laparoscopic and robot-assisted laparoscopic surgery using different anti-reflux ureter bladder anastomoses are safe and effective approaches in the minimally invasive treatment of congenital megaureter.
为报告我们在先天性巨输尿管的单纯腹腔镜及机器人辅助腹腔镜重建手术方面的经验，7例（1例双侧）有症状的先天性巨输尿管患者接受了单纯腹腔镜或机器人辅助腹腔镜手术。在血管水平暴露巨输尿管，并将其游离至膀胱狭窄区域。通过单纯腹腔镜或机器人辅助腹腔镜手术在腹腔内进行输尿管极短缩及黏膜下隧道包埋或乳头植入以及抗反流输尿管膀胱吻合术。分析了7例患者术后的临床资料，包括手术时间、术中并发症、术中出血量、术后并发症、术后住院时间及病理结果。所有患者均获随访。7例患者手术均成功完成。单纯腹腔镜手术和机器人辅助腹腔镜手术的平均手术时间分别为175（范围：150 - 220）分钟和187（范围：170 - 205）分钟，平均术中失血量分别为20（范围：10 - 30）毫升和28.75（范围：15 - 20）毫升。术中无并发症发生。术后引流时间分别为5（范围：4 - 6）天和5.75（范围：5 - 6）天，留置导尿管时间分别为6.33（范围：4 - 8）天和7（范围：7 - 7）天。术后住院时间分别为7.67（范围：7 - 8）天和8（范围：7 - 10）天。术后无明显疼痛、无继发性出血及尿漏。术后病理报告显示为慢性尿路上皮黏膜炎症。随访结果证实所有患者症状均缓解。单纯腹腔镜及机器人辅助腹腔镜手术采用不同的抗反流输尿管膀胱吻合术均是先天性巨输尿管微创治疗的安全有效方法。
