Başataç Cem, Boylu Uğur, Önol Fikret Fatih, Gümüş Eyüp
Depatment of Urology, Ümraniye Teaching Hospital, İstanbul, Turkey.
Turk J Urol. 2014 Mar;40(1):24-30. doi: 10.5152/tud.2014.06956.
To compare the surgical and functional outcomes of open, laparoscopic and robotic dismembered pyeloplasty for the treatment of patients with ureteropelvic junction obstruction (UPJO).
Between 2007 and 2012, a total of 56 patients underwent conventional open (Group 1; n=25), laparoscopic (Group 2; n=16), and robotic (Group 3; n=15) dismembered pyeloplasty operations. Preoperative evaluation was performed using urinalysis, urine culture, blood biochemistry, urinary ultra-sound, intravenous pyelogram (IVP) (optional) and Mercaptoacetyltriglycine (MAG-3) renal scan. The mean operation time, estimated blood loss, drain removal time, narcotic analgesic requirements, length of hospital stay and functional outcomes were compared among groups. Statistical analyses were performed using Statistical Package for the Social Sciences (SPSS) v. 20 (IBM, Armonk, NY, USA) software, and statistically significant differences were determined using a p value <0.05.
The mean age of the patients was 30 years in Group 1, 34.3 years in Group 2 and 32.9 years in Group 3. The mean operation time was 127, 130 and 114 min (p=0.32), and the estimated blood loss was 105, 31 and 28 mL, respectively (p=0.001). The drain was removed after 4.36 (±1.3), 2.33 (±0.6) and 1.8 (±0.6) days after surgery (p<0.001), and the mean hospital stay was 4.14 (±1.8), 2.8 (±0.75) and 2 (±1) days, respectively (p<0.001). Narcotic analgesic requirement was significantly higher in Group 1 compared with Groups 2 and 3 (p=0.02). The radiographic and symptomatic success rates were 96% in Group 1, 93.75% in Group 2 and 93.3% in Group 3.
Laparoscopic and robotic pyeloplasty are feasible, effective, reliable and minimally invasive treatment approaches for the treatment of UPJO as compared with open dismembered pyeloplasty.
比较开放手术、腹腔镜手术及机器人辅助离断性肾盂成形术治疗输尿管肾盂连接部梗阻（UPJO）患者的手术效果及功能结局。
2007年至2012年期间，共有56例患者分别接受了传统开放手术（第1组；n = 25）、腹腔镜手术（第2组；n = 16）及机器人辅助手术（第3组；n = 15）离断性肾盂成形术。术前评估采用尿液分析、尿培养、血液生化、泌尿系统超声、静脉肾盂造影（IVP，可选）及巯基乙酰三甘氨酸（MAG-3）肾动态显像。比较各组的平均手术时间、估计失血量、引流管拔除时间、麻醉性镇痛药需求量、住院时间及功能结局。使用社会科学统计软件包（SPSS）v. 20（IBM，美国纽约州阿蒙克）软件进行统计分析，采用p值<0.05确定统计学显著差异。
第1组患者的平均年龄为30岁，第2组为34.3岁，第3组为32.9岁。平均手术时间分别为127、130和114分钟（p = 0.32），估计失血量分别为105、31和28毫升（p = 0.001）。术后引流管分别在4.36（±1.3）、2.33（±0.6）和1.8（±0.6）天拔除（p<0.001），平均住院时间分别为4.14（±1.8）、2.8（±0.75）和2（±1）天（p<0.001）。第1组的麻醉性镇痛药需求量显著高于第2组和第3组（p = 0.02）。第1组的影像学及症状缓解成功率为96%，第2组为93.75%，第3组为93.3%。
与开放离断性肾盂成形术相比，腹腔镜及机器人辅助肾盂成形术是治疗UPJO可行、有效、可靠且微创的治疗方法。
