机器人辅助腹腔镜联合输尿管软镜治疗合并肾结石的肾盂输尿管连接部梗阻

doi:10.19558/j.cnki.10-1020/r.2017.02.004

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摘要 目的:探讨机器人辅助腹腔镜肾盂成型术联合输尿管软镜取石术治疗合并肾结石的肾盂输尿管连接部梗阻(UPJO)的可行性及有效性。方法:回顾性分析2013年3月~2015年9月因UPJO合并肾结石而接受机器人辅助腹腔镜肾盂成型术联合输尿管软镜取石手术治疗的12例患者临床资料,左侧UPJO 5例,右侧UPJO 7例,其中合并单发肾下极结石7例,多发肾结石5例。B超提示重度肾积水4例、中度5例、轻度3例。结果:12例患者均顺利完成手术,总手术时间平均(128.6±26.3)min,软镜手术时间平均(30.2±13.5)min,失血量平均(37.1±9.7)ml,住院时间平均(6.2±1.5)d,无严重手术并发症,无中转开放手术。术后随访12~42个月,结石清除率达100%;12例患者腰痛症状均消失,逆行肾盂造影示UPJO吻合口无狭窄,肾积水减轻;4例重度肾积水者中1例转为中度、3例转为轻度;5例中度积水者中2例转为轻度、3例积水消失;3例轻度肾积水者积水消失。结论:机器人辅助腹腔镜联合输尿管软镜手术治疗合并肾结石的UPJO临床效果好,具有可行性。

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关键词 ：肾盂输尿管连接部梗阻, 机器人辅助腹腔镜肾盂成型术, 肾结石, 输尿管软镜取石术

Abstract：Objective: To evaluate the efficacy and feasibility of the robot-assisted laparoscopic pyeloplasty (RALP) combined with flexible ureteroscope lithtripsy (f-URL) for treatment of ureteropelvic junction obstruction (UPJO) with renal calculi. Methods: We retrospectively reviewed the records of 12 patients who underwent RALP and f-URL for UPJO with renal calculi from March 2013 to September 2015. Three cases had solitary stones located at the lower calyx, and the other two had multiple stones. Of 12 cases of UPJO, there were 7 cases in the right kidney, and 5 cases in the left kidney. Seven cases had solitary stones located at the lower calyx, and the rest 5 cases had multiple stones. B-ultrasound examination showed that severe hydronephrosis occurred in 4 cases, intermediate in 5 cases, and mild in 3 cases. Results: The operation was successful in all the 12 patients with no severe complications. The average total operation time was (128.6±26.3) min and the average f-URL time was (30.2±13.5) min. The average blood loss was (37.1±9.7) mL and the average hospital stay length was (6.2±1.5) days. No conversions to open surgery were required. During the postoperative follow-up period of 12 to 42 months, the stone-free rate was 100%. Lumbago disappeared in 12 cases and there was no stricture at UPJ by retrograde pyelography. Hydronephrosis was remitted (among 4 cases with severe hydronephrosis, hydrops remitted from severe to interm ediate in 1 and to mild in 3; among 5 cases with intermediate hydronephrosis, hydrops remitted from interm ediate to mild in 2 and 3 had resolution: 3 cases with mild hydronephrosis had resolution). Conclusions: RALP combined with f-URL is effective and feasible for treatment of UPJO with renal calculi.

Key words： ureteropelvic junction obstruction robot-assisted laparoscopic pyeloplasty renal stone flexible ureteroscope lithtripsy

收稿日期: 2016-10-22

ZTFLH:

R692

基金资助:陕西省科技统筹创新工程项目(2012KTCL03-03);陕西省社发攻关项目(2016SF-162)

通讯作者: 袁建林,jianliny@fmmu.edu.cn

引用本文:

王福利,杨力军,刘飞,杨晓剑,王延柱,孟平,武鹏,张龙龙,秦卫军,袁建林. 机器人辅助腹腔镜联合输尿管软镜治疗合并肾结石的肾盂输尿管连接部梗阻[J]. 微创泌尿外科杂志, 2018, 7(s1): 12-.
Wang Fuli, Yang Lijun, Liu Fei, Wang Yanzhu, Meng Ping, Wu Peng, Yang Xiaojian, Qin Weijun, Yuan Jianlin. Concomitant treatment of robot-assisted laparoscopic surgery and flexible ureteroscope lithtripsy for ureteropelvic junction obstruction with renal calculi. JOURNAL OF MINIMALLY INVASIVE UROLOGY, 2018, 7(s1): 12-.

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http://journal20.magtechjournal.com/Jwk_zgmnwk/CN/abstract/abstract1394.shtml 或 http://journal20.magtechjournal.com/Jwk_zgmnwk/CN/Y2018/V7/Is1/12

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