Ding Guangpu, Cheng Sida, Li Xinfei, Fang Dong, Yang Kunlin, Tang Qi, Zhang Peng, Hao Han, Li Xuesong, Zhou Liqun
Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Center, Beijing, China.
Department of Urology, Emergency General Hospital, Beijing, China.
Transl Androl Urol. 2021 Jan;10(1):56-65. doi: 10.21037/tau-20-789.
To summarize our experience with the Boari flap-psoas hitch and compare the indications, perioperative data and outcomes between open and laparoscopic procedures.
This study retrospectively reviewed 35 patients with complex distal ureteral stricture between January 2015 and April 2019. All patients were treated with Boari flap-psoas hitch by either an open or a laparoscopic procedure. Selection criteria were based on the etiology, comorbidities, medical history, and patient preference.
All surgeries were performed successfully. The median operation time was 201 min (range, 120 to 300 min), and the median estimated blood loss was 50 mL (range, 20 to 400 mL). The median postoperative hospitalization was 9 days (range, 3 to 46 days). Nineteen patients were treated by the open procedure, and 16 were treated by the transperitoneal laparoscopic procedure. The surgical indication of open surgery was broader than that for laparoscopic surgery. For patients experiencing iatrogenic injury and ureterovesical reimplantation failure, no significant differences in sex, laterality, operative time, ASA score or postoperative hospitalization stay were observed between the two groups. The median estimated blood loss was lower in the laparoscopic group than in the open group (P=0.047). Patients in the open group had more surgical complications than patients in the laparoscopic group (P=0.049). The postoperative follow-up showed the radiological resolution of hydronephrosis in 33 patients.
With the appropriate surgical considerations, Boari flap-psoas hitch is a valid method to bridge distal ureteral defects. For select patients, laparoscopic surgery had advantages being a minimal invasive surgery with less estimated blood loss and fewer surgical complications.
总结我们使用鲍里皮瓣-腰大肌固定术的经验，并比较开放手术和腹腔镜手术的适应症、围手术期数据及结果。
本研究回顾性分析了2015年1月至2019年4月期间35例复杂性远端输尿管狭窄患者。所有患者均接受了开放或腹腔镜鲍里皮瓣-腰大肌固定术治疗。选择标准基于病因、合并症、病史及患者偏好。
所有手术均成功完成。中位手术时间为201分钟（范围120至300分钟），中位估计失血量为50毫升（范围20至400毫升）。中位术后住院时间为9天（范围3至46天）。19例患者接受开放手术治疗，16例接受经腹腹腔镜手术治疗。开放手术的手术适应症比腹腔镜手术更广泛。对于医源性损伤和输尿管膀胱再植失败的患者，两组在性别、患侧、手术时间（手术时长）、美国麻醉医师协会（ASA）评分或术后住院时间方面未观察到显著差异。腹腔镜组的中位估计失血量低于开放组（P = 0.047）。开放组患者的手术并发症比腹腔镜组更多（P = 0.049）。术后随访显示33例患者肾积水的影像学表现得到缓解。
在进行适当的手术考量后，鲍里皮瓣-腰大肌固定术是修复远端输尿管缺损的有效方法。对于部分患者，腹腔镜手术作为微创手术具有估计失血量更少、手术并发症更少的优势。
