机器人辅助腹腔镜下膀胱外跨三角区输尿管再植术并针对原发性梗阻性巨输尿管进行个体化治疗
Robot-assisted Laparoscopic Extravesical Cross-trigonal Ureteral Reimplantation With Tailoring for Primary Obstructive Megaureter.
作者信息
Neheman Amos, Shumaker Andrew, Gal Jonathan, Haifler Miki, Kord Eyal, Rappaport Yishai H, Zisman Amnon, Noh Paul, Chertin Boris
机构信息
Department of Urology, Shamir Medical Center (Assaf Harofeh), Zerifin, Israel, Affiliated to the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
Department of Urology, Shamir Medical Center (Assaf Harofeh), Zerifin, Israel, Affiliated to the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
出版信息
Urology. 2019 Dec;134:243-245. doi: 10.1016/j.urology.2019.09.003. Epub 2019 Sep 19.
OBJECTIVE
To describe a novel, minimally invasive surgical technique, robotic-assisted laparoscopic dismembered extravesical cross-trigonal ureteral reimplantation for primary obstructive megaureter and to report a case series of 13 patients.
METHODS
Thirteen patients between the ages of 10 and 96 months who were diagnosed with primary obstructive megaureter underwent robotic-assisted laparoscopic dismembered extravesical cross-trigonal ureteral reimplantation between April 2017 and May 2019. The principle of this technique is performing an extravesical cross-trigonal ureteral reimplantation with intracorporeal tailoring of the ureter. This provides the advantage of achieving a long tunnel mimicking the Cohen cross-trigonal ureteral reimplantation, without performing the open surgical technique and offers the potential benefits of minimally invasive surgery. Surgical technique is described, demographic data and intra- and/or postoperative parameters are reported.
RESULTS
Median age was 26 months (IQR 16-60). Median weight was 15 kg (IQR 10.1-31). Median console time was 113 minutes (IQR 90.5-140). Median postoperative stay was 2.5 days (IQR 1.3-3). Median ureteral diameter decreased from 17 mm (IQR 12.5-18.5) to 3 mm (IQR 0-6.5, P = .001). Median renal pelvis diameter decreased from 28 mm (IQR 20.5-37.8) to 4 mm (IQR 1.5-5, P = .005). Median renal function before surgery was 46% (IQR 24.5-48.5) and following surgery was 42% (IQR 36-42, P = .700). Median T decreased from 28 minutes (IQR 19.3-30) to 4.5 minutes (IQR 3-5, P = .009). Postoperative complications graded by the Clavien-Dindo classification were apparent in 3 patients (21%). One had grade I complication (fever, resolved spontaneously) and 2 had a Grade II complication (urinary tract infection).
CONCLUSION
Robot-assisted cross-trigonal ureteral reimplantation with intracorporeal tailoring is safe, feasible, and reproducible in short-term follow-up.
目的
描述一种新型的微创手术技术，即机器人辅助腹腔镜下离断式膀胱外跨三角区输尿管再植术治疗原发性梗阻性巨输尿管，并报告13例患者的病例系列。
方法
2017年4月至2019年5月，13例年龄在10至96个月之间、诊断为原发性梗阻性巨输尿管的患者接受了机器人辅助腹腔镜下离断式膀胱外跨三角区输尿管再植术。该技术的原则是在膀胱外进行跨三角区输尿管再植术，并在体内对输尿管进行剪裁。这具有实现类似科恩跨三角区输尿管再植术的长隧道的优势，而无需进行开放手术，并且具有微创手术的潜在益处。描述了手术技术，报告了人口统计学数据以及术中及术后参数。
结果
中位年龄为26个月（四分位间距16 - 60）。中位体重为15千克（四分位间距10.1 - 31）。中位控制台操作时间为113分钟（四分位间距90.5 - 140）。中位术后住院时间为2.5天（四分位间距1.3 - 3）。输尿管中位直径从17毫米（四分位间距12.5 - 18.5）降至3毫米（四分位间距0 - 6.5，P = 0.001）。肾盂中位直径从28毫米（四分位间距20.5 - 37.8）降至4毫米（四分位间距1.5 - 5，P = 0.005）。术前中位肾功能为46%（四分位间距24.5 - 48.5），术后为42%（四分位间距36 - 42，P = 0.700）。中位T从28分钟（四分位间距19.3 - 30）降至4.5分钟（四分位间距3 - 5，P = 0.009）。根据Clavien - Dindo分类法分级的术后并发症在3例患者（21%）中出现。1例有I级并发症（发热，自行缓解），2例有II级并发症（尿路感染）。
结论
在短期随访中，机器人辅助的跨三角区输尿管再植术及体内剪裁是安全、可行且可重复的。
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