机器人辅助 Boari 皮瓣和腰大肌悬吊带输尿管再植术：≥1 年随访的病例系列的技术见解和结果。
Robot-assisted Boari flap and psoas hitch ureteric reimplantation: technique insight and outcomes of a case series with ≥1 year of follow-up.
机构信息
Department of Urology, Onze-Lieve-Vrouw Hospital, Aalst, Belgium.
ORSI Academy, Melle, Belgium.
出版信息
BJU Int. 2021 Nov;128(5):625-633. doi: 10.1111/bju.15421. Epub 2021 May 5.
OBJECTIVE
To describe step-by-step surgical techniques and report outcomes of the largest single-centre series of patients with distal ureteric disease exclusively treated with robot-assisted ureteric reimplantation with Boari flap (RABFUR) and psoas hitch (RAPHUR), with a minimum follow-up of 1 year and complete postoperative data.
PATIENTS AND METHODS
A total of 37 patients with distal ureteric disease were treated between 2010 and 2018. Of these, 81% and 19% underwent RAPHUR and RABFUR, respectively. Intra-, peri- and postoperative outcomes were assessed. The 90-day postoperative complications were reported according to the standardised methodology proposed by the European Association of Urology Ad Hoc Panel. Functional outcomes (creatinine, estimated glomerular filtration rate [eGFR]) and postoperative symptoms (visual analogue pain scale) were assessed.
RESULTS
The median operating time and blood loss were 180 min and 100 mL, respectively. There were no conversions to open surgery and no intraoperative transfusions. The median length of stay, bladder catheter indwelling time and stent removal were 4, 7 and 30 days, respectively. The median follow-up was 24 months. Overall, 10 patients (27%) had postoperative complications and of these, eight (22%) and two (5.4%) were Clavien-Dindo Grade I-II and III, respectively. At the last follow-up, the median postoperative creatinine level and eGFR were 0.9 mg/dL and 73.5 mL/min/1.73 m , respectively. At the last follow-up, five (13.5%) and three (8%) patients had Grade 1 hydronephrosis and mild urinary symptoms, respectively. The study limitations include its retrospective nature.
CONCLUSION
In the present study, we present our RABFUR and RAPHUR techniques. We confirm the feasibility and safety profile of both approaches in patients with distal ureteric disease relying on the largest single-centre series with ≥1 year of follow-up.
目的
描述分步手术技术，并报告在最大的单中心系列患者中，专门采用机器人辅助输尿管再植术联合 Boari 皮瓣（RABFUR）和腰大肌悬带（RAPHUR）治疗远端输尿管疾病的结果，这些患者的随访时间均至少为 1 年且具有完整的术后数据。
患者和方法
2010 年至 2018 年间，共有 37 例远端输尿管疾病患者接受了治疗。其中，81%和 19%的患者分别接受了 RAPHUR 和 RABFUR。评估了患者的围手术期结果。根据欧洲泌尿外科学会特别小组提出的标准化方法报告了 90 天术后并发症。评估了患者的功能结果（肌酐、估算肾小球滤过率[eGFR]）和术后症状（视觉模拟疼痛量表）。
结果
中位手术时间和出血量分别为 180 分钟和 100 毫升。无中转开放手术且无术中输血。中位住院时间、膀胱导管留置时间和支架取出时间分别为 4、7 和 30 天。中位随访时间为 24 个月。总体而言，有 10 例患者（27%）发生了术后并发症，其中 8 例（22%）和 2 例（5.4%）为 Clavien-Dindo Ⅰ-Ⅱ级和Ⅲ级。末次随访时，中位术后肌酐水平和 eGFR 分别为 0.9mg/dL 和 73.5mL/min/1.73m2。末次随访时，5 例（13.5%）和 3 例（8%）患者分别存在 1 级肾积水和轻度泌尿道症状。研究局限性包括其回顾性性质。
结论
在本研究中，我们介绍了 RABFUR 和 RAPHUR 技术。我们证实了这两种方法在远端输尿管疾病患者中的可行性和安全性，这些患者的单中心系列样本最大，随访时间至少为 1 年。
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