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机器人辅助输尿管输尿管吻合术在输尿管镜碎石术后复杂性输尿管狭窄患者中的疗效

Efficacy of Robot-Assisted Ureteroureterostomy in Patients with Complex Ureteral Stricture after Ureteroscopic Lithotripsy.

作者信息

Hamamoto Shuzo, Taguchi Kazumi, Kawase Kengo, Unno Rei, Isogai Masahiko, Torii Koei, Iwatsuki Shoichiro, Etani Toshiki, Naiki Taku, Okada Atsushi, Yasui Takahiro

机构信息

Department of Nephro-Urology, Nagoya City University Graduate School of Medical Sciences, Nagoya 4678601, Japan.

出版信息

J Clin Med. 2023 Dec 16;12(24):7726. doi: 10.3390/jcm12247726.

Abstract

BACKGROUND

Ureteral stricture (US) postureteroscopic lithotripsy (URSL) has emerged as a severe complication with the widespread use of laser technology. Furthermore, managing a complex US is challenging. Therefore, this study evaluated the efficacy of robot-assisted ureteroureterostomy (RAUU) in addressing US post-URSL and analyzed the pathology of transected ureteral tissues to identify the risk factors for US.

METHODS

we conducted a prospective cohort study on patients who underwent RAUU for URSL-induced US from April 2021 to May 2023.

RESULTS

A total of 14 patients with a mean age of 49.8 years were included in this study. The mean stricture length on radiography was 22.66 ± 7.38 mm. Nine (64.2%) patients had experienced failure with previous interventions. The overall success rate was 92.9%, both clinically and radiographically, without major complications, at a mean follow-up of 12.8 months. The pathological findings revealed microcalcifications and a loss of ureteral mucosa in 57.1% and 28.6% of patients, respectively.

CONCLUSIONS

The RAUU technique shows promise as a viable option for US post-URSL in appropriately selected patients despite severe pathological changes in the ureter. Therefore, the migration of microcalcifications to the site of ureteral perforation may be a significant factor contributing to US development.

摘要

背景

输尿管镜碎石术(URSL)后输尿管狭窄(US)已成为激光技术广泛应用后的一种严重并发症。此外,处理复杂的US具有挑战性。因此,本研究评估了机器人辅助输尿管输尿管吻合术(RAUU)在解决URSL后US方面的疗效,并分析了切断的输尿管组织的病理情况,以确定US的危险因素。

方法

我们对2021年4月至2023年5月因URSL导致的US而接受RAUU的患者进行了一项前瞻性队列研究。

结果

本研究共纳入14例患者,平均年龄49.8岁。影像学检查显示平均狭窄长度为22.66±7.38mm。9例(64.2%)患者既往干预失败。平均随访12.8个月时,临床和影像学上的总体成功率为92.9%,无重大并发症。病理结果显示,分别有57.1%和28.6%的患者出现微钙化和输尿管黏膜缺失。

结论

尽管输尿管存在严重的病理改变,但对于适当选择的患者,RAUU技术有望成为URSL后US的一种可行选择。因此,微钙化向输尿管穿孔部位的迁移可能是导致US发生的一个重要因素。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/7430/10743600/8b8455714b48/jcm-12-07726-g001.jpg

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