Division of Urology, Department of Surgery, Tungs' Taichung MetroHarbor Hospital, No. 699, Sec. 8, Taiwan Blvd., Wuqi Dist., Taichung City, 435403, Taiwan.
Department of Nursing, Jen-Teh Junior College of Medicine. Nursing and Management, Miaoli, 356, Taiwan.
J Robot Surg. 2022 Oct;16(5):1009-1017. doi: 10.1007/s11701-021-01331-3. Epub 2021 Nov 8.
Although ureteroplasty with buccal mucosa graft for long-segmental ureteral stenosis has been developed long ago, evidence was still restricted to case series in published literature. This study aims to validate ureteroplasty with buccal mucosa graft (BMG) in long-segment stricture at the proximal and middle ureters under designed comparative methods. From April 2015 to January 2019, we performed robotic-assisted ureteroplasty with BMG with a two-phase design and compared ureteroplasty and BMG (phase 2 surgery) with endoscopic stenting (phase 1 surgery). Paired data of effective renal plasma flow (ERPF), glomerular filtration rate (GFR), hydronephrosis grade, and physical and psychological domains of the World Health Organization Quality of Life (WHOQOL)-BREF were compared. A total of 29 patients were enrolled, and only three (10%) patients had hydronephrosis resolution after treatment with endoscopic stenting (p = 0.250 to baseline). Compared to endoscopic ureteral stent, Hedges' g of ureteroplasty with BMG was 0.56 (95% CI 0.43-0.69), 0.63 (95% CI 0.46-0.80), 0.80 (95% CI 0.56-1.04), and 1.06 (95% CI 0.69-1.43) in EGFR, GFR, physical domain of WHOQOL-BREF, and psychological domain of WHOQOL-BREF, respectively (All significance; p < 0.001). After 12-month follow-ups, no recurrence of stricture was reported. In conclusion, Robotic-assisted ureteroplasty with BMG onlay is efficient in reconstruction of long-segment stricture of the proximal and middle ureters.
虽然使用颊黏膜移植物进行长段输尿管狭窄的输尿管成形术早已发展成熟，但相关证据仍然局限于已发表文献中的病例系列研究。本研究旨在通过设计对比方法验证在近端和中段输尿管长段狭窄中应用颊黏膜移植物（BMG）进行输尿管成形术的效果。2015 年 4 月至 2019 年 1 月，我们采用机器人辅助的分两阶段设计进行 BMG 输尿管成形术，并将输尿管成形术和 BMG（第 2 阶段手术）与内镜下支架置入术（第 1 阶段手术）进行对比。对比分析有效肾血浆流量（ERPF）、肾小球滤过率（GFR）、肾积水分级以及世界卫生组织生活质量（WHOQOL）-BREF 量表的身体和心理领域的配对数据。共纳入 29 例患者，仅有 3 例（10%）患者经内镜下支架置入治疗后肾积水得到缓解（p=0.250 与基线相比）。与内镜下输尿管支架相比，BMG 输尿管成形术的 Hedges' g 值在 ERPF、GFR、WHOQOL-BREF 量表的身体领域和心理领域中分别为 0.56（95%CI 0.43-0.69）、0.63（95%CI 0.46-0.80）、0.80（95%CI 0.56-1.04）和 1.06（95%CI 0.69-1.43）（均具有统计学意义；p<0.001）。12 个月随访期间，无狭窄复发病例报告。总之，机器人辅助的 BMG 输尿管成形术在重建近端和中段输尿管长段狭窄中是有效的。
