Liu Qi,Xing Xinrang,Zeng Xiaoxu,et al.A comparative efficacy study of robot-assisted laparoscopy versus conventional laparoscopy for pelvic ureteral junction obstruction in children[J].Journal of Clinical Pediatric Surgery,2023,22(07):660-665.[doi:10.3760/cma.j.cn101785-202211037-011]
机器人辅助腹腔镜与传统腹腔镜治疗儿童肾盂输尿管连接部梗阻的疗效对比
- Title:
- A comparative efficacy study of robot-assisted laparoscopy versus conventional laparoscopy for pelvic ureteral junction obstruction in children
- Keywords:
- Robotic Surgical Procedures; Laparoscopes; Ureteral Diseases; Surgical Procedures; Operative; Child
- 摘要:
- 目的 对比机器人辅助腹腔镜与传统腹腔镜治疗儿童肾盂输尿管连接部梗阻（ureteropelvic junction obstruction，UPJO）的疗效。方法 本研究为回顾性研究，以2021年1月至2022年5月在宁夏医科大学总医院小儿外科接受UPJO治疗的63例患儿为研究对象，其中31例接受机器人辅助下腹腔镜肾盂成形术（robot-assisted laparoscopic pyeloplasty，RALP），为RALP组；32例接受传统腹腔镜下肾盂成形术（laparoscopic pyeloplasty，LP），为LP组。对比分析两组患儿年龄、性别、体重、手术时间、术中估计出血量、术后引流时间、术后住院时间和住院费用、肾盂前后径（anteroposterior diameter，APD）、肾盂与肾实质厚度比值（pelvis/cortex ratio，PCR）、分肾功能（differential renal function，DRF）等临床资料。结果 两组均无一例中转开放手术。RALP组手术时间（119.87±15.64）min，LP组手术时间（128.53±36.27）min，差异无统计学意义（P>0.05）。RALP组术中出血量5（3，5）mL，术后引流时间5（5，6）d，术后住院时间（7.13±1.59）d，住院费用（45 506.81±1 717.28）元；LP组术中出血量5（5，10）mL，术后引流时间6（5，8）d，术后住院时间（8.81±3.35）d，住院费用（18 854.06±1 575.80）元；上述指标差异均有统计学意义（P<0.05）。两组术后随访5~15个月，术后3个月APD、PCR均较术前改善，术后6个月APD、PCR均较术前改善，差异均有统计学意义（P<0.05）；术后6个月时，RALP组与LP组APD差异具有统计学意义（P<0.05）。两组术后并发症发生率比较，差异无统计学意义（P>0.05）。结论 机器人辅助腹腔镜手术相比传统腹腔镜手术治疗UPJO在术后引流时间及住院时间方面有一定优势，术后恢复较快，应用前景较好；若能进一步控制治疗费用，可作为治疗儿童UPJO的一线选择。
- Abstract:
- Objective To explore the efficacy of robot-assisted laparoscopy versus conventional laparoscopy for ureteropelvic junction obsruction (UPJO) in children.Methods Retrospective review was conducted for clinical data of 63 UPJO children from January 2021 to May 2022.Robot-assisted laparoscopic pyeloplasty (RALP, n=31) and conventional laparoscopic pyeloplasty (RALP, n=32) were performed.General profiles such as age, gender, weight and affected side were recorded along with clinical data such as operative duration, estimated intraoperative hemorrhage, postoperative drainage time, postoperative hospital stay and hospitalization expenditure, as well as anterior-posterior diameter of renal pelvis (APD), pelvis-to-parenchyma thickness ratio (pelvis/cortex ratio, PCR) and fractional renal pelvis thickness ratio.PCR, differential renal function (DRF) and other imaging data were analyzed for determining which surgical procedure was more advantageous among UPJO, RALP and LP.Results All procedures were completed successfully and there was no conversion into open surgery.Operative duration in RALP group was comparable to that in LP group[(119.87±15.64) vs.(128.53±36.27) min]and the differences were not statistically significant (P>0.05).When RALP and LP groups were compared, hemorrhagic volume was[5(3-5) vs.5(5-10) mL], postoperative drainage time[5(5-6) vs.6(5-8) day], postoperative hospitalization time[(7.13±1.59) vs.(8.81±3.35) day]and hospitalization expenditure[(45 506.81±1 717.28) vs.(18 854.06±1 575.80) yuan].The differences were statistically significant.The postoperative follow-up period was (5-15) month for both groups.At Month 3 post-operation, APD and PCR were different before and after operation.At Month 6 post-operation, APD and PCR were different before and after operation.The differences were statistically significant (P<0.05).At Month 6 post-operation, APD differed between RALP and LP groups (P<0.05).The inter-group difference in postoperative occurrence of complications was not statistically significant (P>0.05).Conclusion Robot-assisted laparoscopy offers some advantages over conventional laparoscopy in terms of postoperative drainage time and hospital stay in UPJO children.With faster postoperative recovery and excellent application prospects, it may be promoted as a first-line option for UPJO children if expenditure is strictly controlled.
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备注/Memo
收稿日期:2022-11-17。
通讯作者:苏泽礼,Email:suzeli188@sina.com