Liu Huazhang,Ru Wei,Tao Chang,et al.Comparison of robot-assisted laparoscopic Lich-Gregoir procedure vetsus pneumovesical Politano-Leadbetter ureteral reimplantation for treating primary vesicoureteral reflux in infants and young children[J].Journal of Clinical Pediatric Surgery,2025,(07):622-627.[doi:10.3760/cma.j.cn101785-202504032-005]
机器人辅助腹腔镜Lich-Gregoir术与气膀胱Politano-Leadbetter输尿管再植术治疗婴幼儿原发性膀胱输尿管反流的对比研究
- Title:
- Comparison of robot-assisted laparoscopic Lich-Gregoir procedure vetsus pneumovesical Politano-Leadbetter ureteral reimplantation for treating primary vesicoureteral reflux in infants and young children
- 摘要:
- 目的 比较机器人辅助腹腔镜Lich-Gregoir术与气膀胱Politano-Leadbetter输尿管再植术治疗婴幼儿原发性膀胱输尿管反流(vesicoureteral reflux,VUR)的临床疗效及安全性。方法 回顾性分析2021年1月至2024年10月浙江大学医学院附属儿童医院收治的54例婴幼儿原发性VUR患者临床资料,其中28例行机器人辅助Lich-Gregoir术(为机器人组),26例行气膀胱Politano-Leadbetter术(为气膀胱组)。比较两组患儿操作通道建立时间、手术时间、留置导尿管时间、住院时长、术后情况等指标。结果 机器人组手术时间[(95.4±20.6) min比(127.1±24.5) min]、留置导尿管时间[4.5(4.0,5.8) d比6.0(5.0,8.0) d]、住院时长[7.0(6.0,7.8) d比8.0(7.0,10.0) d]显著短于气膀胱组,差异有统计学意义(P＜0.05);两组通道建立时间[(14.9±3.6) min比(16.5±4.6) min]差异无统计学意义(P＞0.05)。机器人组术后无一例尿外渗发生,气膀胱组2例出现尿外渗(1例经保守治疗后痊愈,1例行“输尿管支架+盆腔引流管置入”后痊愈)。机器人组有1例术后1个月出现尿路感染,予抗感染治疗后痊愈;1例术后3个月复查排尿性膀胱尿道造影提示Ⅰ级反流,该患儿无临床症状,门诊继续随访。气膀胱组有2例出现泌尿道感染,予保守治疗后痊愈;2例出现VUR(1例Ⅰ级、1例Ⅱ级),均无临床症状,予以门诊随访。两组均无一例出现输尿管梗阻及需要二次尿路重建,肾积水及输尿管扩张均缓解。结论 两种微创术式治疗婴幼儿原发性VUR均疗效确切。机器人辅助Lich-Gregoir术在治疗婴幼儿原发性VUR中具有手术时间短、术后恢复快、并发症少等优势,是一种安全有效的微创术式。
- Abstract:
- Objective To compare the clinical efficacy and safety of robot-assisted laparoscopic Lich-Gregoir ureteral reimplantation versus pneumovesical Politano-Leadbetter ureteral reimplantation for the treatment of primary vesicoureteral reflux (VUR) in infants and young children. Methods A retrospective analysis was conducted on the clinical data of 54 infants and young children with primary VUR treated from January 2021 to October 2024.Among them,28 patients underwent robot-assisted Lich-Gregoir surgery (robotic group),and 26 patients underwent pneumovesical Politano-Leadbetter surgery (pneumovesical group).Key indicators including trocar placement time,operative time,duration of postoperative catheterization,length of hospital stay,and postoperative outcomes were compared between the two groups. Results The robotic group had significantly shorter operative time[(95.4±20.6) min vs.(127.1±24.5) min],catheterization time[4.5(4.0,5.8) days vs.6.0(5.0,8.0 ) days],and hospital stay[7.0(6.0,7.8) days vs.8.0(7.0,10.0) days]compared to the pneumovesical group (P<0.05).There was no significant difference in trocar placement time between the two groups[(14.9±3.6) min vs.(16.5±4.6) min,P>0.05].No cases of urinary leakage occurred in the robotic group,whereas two cases occurred in the pneumovesical group (1 resolved with conservative treatment; 1 required ureteral stent and pelvic drain placement).In the robotic group,1 patient developed a urinary tract infection (UTI) one month postoperatively and recovered after conservative treatment; another patient had Grade Ⅰ reflux detected on VCUG at three-month follow-up without symptoms.In the pneumovesical group,two patients developed UTIs that resolved with conservative management; 2 others showed recurrent VUR (1 Grade Ⅰ,1 Grade Ⅱ) without symptoms and were followed up in outpatient clinics.No patient in either group developed ureteral obstruction,required reoperation,or showed worsening of hydronephrosis or ureteral dilation. Conclusions Both minimally invasive approaches are effective for treating primary VUR in infants and young children.Robot-assisted Lich-Gregoir ureteral reimplantation offers the advantages of shorter operative time,faster recovery,and fewer complications,and is a safe and effective minimally invasive surgical option.
参考文献/References:
[1] 中华医学会小儿外科学分会泌尿外科学组.儿童原发性膀胱输尿管反流的专家共识[J].临床小儿外科杂志,2019,18(10):811-816.DOI:10.3969/j.issn.1671-6353.2019.10.002. Pediatric Urology Group,Branch of Pediatric Surgery,Chinese Medical Association.Expert consensus on management of primary vesicoureteral reflux in children[J].J Clin Ped Sur,2019,18(10):811-816.DOI:10.3969/j.issn.1671-6353.2019.10.002.
[2] Babu R,Chandrasekharam VVS.A systematic review and meta-analysis comparing outcomes of laparoscopic extravesical versus trans vesicoscopic ureteric reimplantation[J].J Pediatr Urol,2020,16(6):783-789.DOI:10.1016/j.jpurol.2020.09.006.
[3] Esposito C,Castagnetti M,Autorino G,et al.Robot? assisted laparoscopic extra-vesical ureteral reimplantation (Ralur/Revur) for pediatric vesicoureteral reflux:a systematic review of literature[J].Urology,2021,156:e1-e11.DOI:10.1016/j.urology.2021.06.043.
[4] Essamoud S,Ghidini F,Andolfi C,et al.Robot-assisted laparoscopic extravesical ureteral reimplantation (RALUR-EV):a narrative review[J].Transl Pediatr,2024,13(9):1634-1640.DOI:10.21037/tp-23-336.
[5] Nascimben F,Molinaro F,Maffi M,et al.Endoscopic injection vs anti-reflux surgery for moderate-and high-grade vesicoureteral reflux in children:a cost-effectiveness international study[J].J Robot Surg,2024,18(1):371.DOI:10.1007/s11701-024-02103-5.
[6] Comez I,Ucar T,Telli O,et al.Does previous endoscopic subureteric injection (STING) effect the outcomes of robot-assisted laparoscopic ureteral reimplantation surgery (RALUR) in children?[J].J Pediatr Urol,2023,19(6):800.e1-800.e6.DOI:10.1016/j.jpurol.2023.07.013.
[7] Ansari MS,Banthia R,Jain S,et al.Long term outcomes of Co-hen’s cross trigonal reimplantation for primary vesicoureteral reflux in poorly functioning kidney[J].World J Clin Cases,2023,11(16):3750-3755.DOI:10.12998/wjcc.v11.i16.3750.
[8] Kruppa C,Fitze G,Schuchardt K.Vesicoscopic cross-trigonal ureteral reimplantation for vesicoureteral reflux:intermediate results[J].Children (Basel),2022,9(2):298.DOI:10.3390/children9020298.
[9] Ya[KG-0.5mm]??z B,Demirel BD.Ureteral reimplantation aligned laparoscopically:pneumovesicoscopic Politano-Leadbetter reimplantation in children[J].J Pediatr Urol,2021,17(3):413.e1-413.e8.DOI:10.1016/j.jpurol.2021.02.007.
[10] Kruppa C,Wilke A,H?rz C,et al.Vesicoscopic vs.open ureteral reimplantation according to Cohen and Leadbetter-Politano for vesicoureteral reflux[J].J Clin Med,2023,12(17):5686.DOI:10.3390/jcm12175686.
[11] Lin S,Xu D,He SH,et al.Ureteral reimplantation for pediatric vesicoureteral reflux and primary obstructive megaureter:transvesicoscopic cohen vs.Politano-Leadbetter approaches[J].J Pediatr Urol,2022,18(4):516.e1-516.e9.DOI:10.1016/j.jpurol.2022.03.009.
[12] Esposito C,Varlet F,Riquelme MA,et al.Postoperative bladder dysfunction and outcomes after minimally invasive extravesical ureteric reimplantation in children using a laparoscopic and a robot-assisted approach:results of a multicentre international survey[J].BJU Int,2019,124(5):820-827.DOI:10.1111/bju.14785.
[13] Casale P,Patel RP,Kolon TF.Nerve sparing robotic extravesical ureteral reimplantation[J].J Urol,2008,179(5):1987-1990.DOI:10.1016/j.juro.2008.01.062.
[14] Kasturi S,Sehgal SS,Christman MS,et al.Prospective long-term analysis of nerve-sparing extravesical robotic-assisted laparoscopic ureteral reimplantation[J].Urology,2012,79(3):680-683.DOI:10.1016/j.urology.2011.10.052.
[15] Gundeti MS,Boysen WR,Shah A.Robot-assisted laparoscopic extravesical ureteral reimplantation:technique modifications contribute to optimized outcomes[J].Eur Urol,2016,70(5):818-823.DOI:10.1016/j.eururo.2016.02.065.
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备注/Memo
收稿日期:2025-4-12。
基金项目:浙江省基础公益研究计划(LGF22H050004)
通讯作者:陈光杰,Email:dr.chenguangjie@zju.edu.cn