Zhu Weiwei,Zhou huixia,Li Pin,et al.Comparison of clinical efficacy of robot-assisted laparoscopic Lich-Gregoir procedure and gas-bladder laparoscopic Cohen ureteral reimplantation for primary vesicoureteral reflux[J].Journal of Clinical Pediatric Surgery,2022,21(05):437-444.[doi:10.3760/cma.j.cn101785-202109034-008]
机器人辅助腹腔镜Lich-Gregoir输尿管再植术与气膀胱Cohen输尿管再植术治疗原发性膀胱输尿管反流的疗效对比
- Title:
- Comparison of clinical efficacy of robot-assisted laparoscopic Lich-Gregoir procedure and gas-bladder laparoscopic Cohen ureteral reimplantation for primary vesicoureteral reflux
- 关键词:
- 原发性膀胱输尿管反流; 机器人手术; 腹腔镜辅助外科手术; 治疗结果; 对比研究
- Keywords:
- Vesicoureteral Reflux; Robotic Surgical Procedures; Laparoscopy; Treatment Outcome; Comparative Study
- 摘要:
- 目的 初步评价机器人辅助腹腔镜Lich-Gregoir输尿管再植术与气膀胱Cohen输尿管再植术治疗儿童原发性膀胱输尿管反流(vesicoureteral reflux,VUR)的临床疗效。方法 将2016年1月至2020年8月解放军总医院第七医学中心儿科医学部行手术治疗的87例VUR患儿纳入研究,按照单侧或双侧VUR将患儿分为单侧组及双侧组,单侧组和双侧组又根据手术方式进一步分为单侧机器人组(25例)、双侧机器人组(22例)、单侧气膀胱组(22例)和双侧气膀胱组(18例)。单侧机器人组和双侧机器人组统称为机器人组,实施机器人辅助腹腔镜Lich-Gregoir输尿管再植术;单侧气膀胱组和双侧气膀胱组统称为气膀胱组,实施气膀胱Cohen输尿管再植术。分别比较单侧组和双侧组中机器人组、气膀胱组的术前准备时间、腹腔内手术操作时间、术中出血量、术后留置尿管天数及术后住院天数。记录各组患儿术后随访情况。结果 所有患儿均顺利完成手术,无一例中转开放手术。在单侧VUR患儿中,机器人组和气膀胱组的术前准备时间分别为(15.3 ±2.9) min和(28.8 ±4.0) min;腹腔内手术操作时间分别为(34.9 ±3.0) min和(46.7 ±8.9) min;留置尿管天数分别为4(3,4) d和4(3,5) d;术中失血量分别为(14.7 ±2.7) mL和(16.8 ±2.8) mL;术后住院天数分别为(8.8 ±2.1) d和(10.5 ±2.8) d。在双侧VUR患儿中,机器人组和气膀胱组的术前准备时间分别为(16.5 ±3.6) min和(20.0 ±2.9) min;腹腔内手术操作时间分别为(81.6 ±8.1) min和(95.9 ±7.9) min;留置尿管天数分别为4(3,5) d和4(3,5) d;术中失血量分别为(36.4 ±7.0) mL和(34.4 ±6.0) mL;术后住院天数分别为7.5(7,9) d和9(7.8,10) d。按照手术方式进行比较,机器人组与气膀胱组患儿术前准备时间[单侧机器人组比单侧气膀胱组为(15.3 ±2.9) min比(28.8 ±4.9) min;双侧机器人组比双侧气膀胱组为(16.5 ±3.6) min比(20.0 ±2.9) min)]、腹腔内手术操作时间[单侧机器人组比单侧气膀胱组为(34.9 ±3.0) min比(46.7 ±8.9) min;双侧机器人组比双侧气膀胱组为(81.6 ±8.1) min比(95.9 ±7.9) min)]以及术后住院天数[单侧机器人组比单侧气膀胱组为(8.8 ±2.1) d比(10.5 ±2.8) d;双侧机器人组比双侧气膀胱组为7.5(7,9) min比9(7.8,10) d]的差异均有统计学意义(P<0.05);而留置尿管天数[单侧机器人组比单侧气膀胱组为4(3,4) d比4(3,5) d;双侧机器人组比双侧气膀胱组为4(3,5) d比4(3,5) d]和术中失血量[单侧机器人组比单侧气膀胱组为(14.7 ±2.7) mL比(16.8 ±2.8) mL;双侧机器人组比双侧气膀胱组为(36.4±7.0) mL比(34.4 ±6.0) mL)]差异无统计学意义(P>0.05)。本研究87例患儿随访1年无一例出现高级别并发症。结论 两种微创输尿管再植术治疗VUR均疗效确切,机器人辅助腹腔镜Lich-Gregoir输尿管再植术手术时间更短,对膀胱的损伤更小,术后恢复更快,但需要更进一步的临床研究来证实。
- Abstract:
- Objective To compare the clinical efficacy of robot-assisted laparoscopic procedure versus gas-bladder laparoscopic Cohen ureteral reimplantation for vesicoureteral reflux. Methods From June 2016 to June 2020,87 children of primary vesicoureteral reflux (VUR) were recruited. According to the presence of bilat- eral/unilateral VUR, they were divided into unilateral and bilateral groups. And bilateral/unilateral VUR groups were further assigned into two groups of unilateral/bilateral robotic (n=25;n=22) and unilateral/bilateral gas- bladder laparoscopic Cohen ureteral reimplantation (n=22;n=18). The relevant clinical data were analyzed, in- cluding preoperative preparation time, intraperitoneal operative duration, intraoperative blood loss, length of ureter- al catheterization and postoperative hospital stay. Postoperative follow-ups were conducted. Results All opera- tions were successful without any conversion. In unilateral VUR children, preoperative preparation time of robotic and gas-bladder groups was (15. 3 ±2. 9) vs. (28. 8 ±4. 0) min, intraperitoneal operative duration (34. 9 ±3. 0) vs. (46. 7 ±8. 9) min, length of ureteral catheterization 4(3,4) vs. 4(3,5) days, intraoperative blood loss (14. 7 ±2. 7) vs. (16. 8 ±2. 8) ml and postoperative hospital stay (8. 8 ±2. 1) vs. (10. 5 ±2. 8) days respectively. In bi- lateral VUR children, preoperative preparation time of robotic and gas-bladder groups was (16. 5 ±3. 6) vs. (20. 0 ±2. 9) min, intraperitoneal operative duration (81. 6 ±8. 1) vs. (95. 9 ±7. 9) min, length of ureteral cath- eterization 4(3,5) vs. 4(3,5) days, intraoperative blood loss (36. 4 ±7. 0) vs. (34. 4 ±6. 0) ml and postopera- tive hospital stay 7. 5(7, 9) vs. 9 (7. 8, 10) days respectively. Among unilateral/bilateral children, preoperative preparation time, intraperitoneal operative duration and postoperative hospital stay showed significant statistical differences between robotic and gas-bladder groups. No statistical differences in intraoperative blood loss or length of ureteral catheterization existed between robotic and gas-bladder groups. There was no high-grade postoperative complication. Conclusion Both mini-invasive ureteral replantations offer definite curative effects. As compared with gas-bladder Cohen laparoscopy, robot-assisted laparoscopic Lich-Gregoir ureteral replantation has a shorter operative duration and recovers faster postoperatively. However, further clinical studies are required.
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备注/Memo
收稿日期:2021-9-13。
基金项目:首都临床特色应用研究（Z181100001718008）；军队计生课题（18JS001）；首都卫生发展科研专项（2016-2-5091）；卫生部行业科研专项（201402007）
通讯作者:周辉霞,Email:huixia99999@163.com