Chen Jingyi,He Shaohua,Xu Di,et al.Comparison of clinical efficacy of single-port robot-assisted laparoscopic ureteral reimplantation versus laparoscopic ureteral reimplantation for primary vesicoureteral reflux in children[J].Journal of Clinical Pediatric Surgery,2023,22(10):930-936.[doi:10.3760/cma.j.cn101785-202304072-006]
单孔机器人辅助腹腔镜输尿管再植术与腹腔镜输尿管再植术治疗膀胱输尿管反流的对比研究
- Title:
- Comparison of clinical efficacy of single-port robot-assisted laparoscopic ureteral reimplantation versus laparoscopic ureteral reimplantation for primary vesicoureteral reflux in children
- Keywords:
- Vesico-Ureteral Reflux; Surgical Procedures; Operative; Robotic Surgical Procedures; Hand-Assisted Laparoscopy; Replantation; Ureter; Treatment Outcome
- 摘要:
- 目的 比较单孔机器人辅助腹腔镜输尿管再植术(robot-assisted laparoscopic ureteral reimplantation,RALUR)与腹腔镜输尿管再植术(laparoscopic ureteral reimplantation,LUR)治疗儿童原发性膀胱输尿管反流(vesicoureteral reflux,VUR)的疗效与应用。方法 回顾性分析2017年1月至2022年4月于福建省立医院小儿外科行手术治疗的70例VUR患儿临床资料,根据手术方式将患儿分为机器人组(采取单孔机器人辅助腹腔镜输尿管再植术)及腹腔镜组(采取腹腔镜输尿管再植术)。机器人组30例,其中单侧反流22例,双侧反流8例;腹腔镜组40例,其中单侧反流30例,双侧反流10例。比较两组术前准备时间、腹腔操作时间、术中出血量、住院时间、手术成功率以及术后并发症发生情况等。结果 两组均手术成功,无一例中转开放手术。手术时间:单侧机器人组(155.18±18.94)min,单侧腹腔镜组(126.33±19.75)min,差异有统计学意义(P＜0.05);双侧机器人组(210.50±19.25)min,双侧腹腔镜组(177.10±16.61)min,差异有统计学意义(P＜0.05)。手术操作时间:单侧机器人组(117.77±23.21)min,单侧腹腔镜组(109.30±10.57)min,差异无统计学意义(P＝0.180);双侧机器人组(169.50±25.48)min,双侧腹腔镜组(158.50±16.67)min,差异无统计学意义(P＝0.285)。术中出血量:机器人组(15.20±3.24)mL,腹腔镜组(25.23±5.84)mL,差异有统计学意义(P＜0.05)。住院时间:机器人组6.5(6.0,7.0)d,腹腔镜组7.0(7.0,8.0)d,差异有统计学意义(P＜0.05)。术后留置导尿管时间:机器人组3.0 (3.0,4.0)d,腹腔镜组3.0 (3.0,4.0)d,差异无统计学意义(P=0.714)。机器人组有1例、腹腔镜组有2例术后出现发热性泌尿系感染(urinary tract infection,UTI),经抗感染治疗后痊愈。机器人组有1例、腹腔镜组有3例术后出现单侧输尿管反流,经预防性口服抗生素治疗3个月后均反流消失。机器人组有1例、腹腔镜组有3例术后出现急性尿潴留,经延长留置导尿时间至术后2周,未再出现尿潴留。结论 单孔机器人辅助腹腔镜输尿管再植术与腹腔镜下输尿管再植术治疗小儿VUR均安全有效,单孔RALUR相对于LUR手术时间长,然而术中出血量少,住院时间短,且单孔RALUR切口美观,具有一定的临床应用价值。
- Abstract:
- Objective To compare the clinical efficacy of single-port robot-assisted laparoscopic ureteral reimplantation (RALUR) versus laparoscopic ureteral reimplantation (LUR) for primary vesicoureteral reflux (VUR) in children.Methods From January 2017 to April 2022,the relevant clinical data were retrospectively reviewed for 70 VUR children.According to surgical approaches,they were assigned into two groups of robot (n=30) and laparoscopy (n=40).Two groups were compared in terms of preoperative preparation time,abdominal operative duration,intraoperative hemorrhage,hospitalization time,surgical success rate and postoperative complications.Results All procedures were successful without any conversion into open surgery.In robot group,reflux was unilateral (n=22) and bilateral (n=8).In laparoscopic group,reflux was unilateral (n=30) and bilateral (n=10).Operative duration: unilateral robotic group min was greater than unilateral laparoscopic group [(155.18±18.94) vs.(126.33±19.75) min].The difference was statistically significant (P<0.05); Bilateral robotic group was greater than bilateral laparoscopic group [(210.50±19.25) vs.(177.10±16.61) min],The difference was statistically significant (P<0.05); Handling duration: unilateral robotic group was longer than unilateral laparoscopic group [(117.77±23.21) vs.(109.30±10.57) min].The difference was statistically insignificant (P=0.180).No significant difference existed between bilateral robotic and bilateral laparoscopic groups [(169.50±25.48) vs.(158.50±16.67) min]; Intraoperative hemorrhage: robotic group was greater than laparoscopic group [(15.20±3.24) vs.(25.23±5.84) ml].The difference was statistically significant (P<0.05); Duration of hospitalization: robotic group was less than laparoscopic group [6.5(6.0,7.0) vs. 7.0(7.0,8.0) day].The difference was statistically significant (P<0.05); Postoperative indwelling time of Foley tube: robotic group was equal to laparoscopic group [3.0(3.0,4.0) vs. 3.0(3.0,4.0) day].The difference was statistically insignificant (P=0.714).One case in robot group and 2 cases in laparoscopic group developed febrile urinary tract infection (UTI) post-operation and recovered after antibiotics treatment.Voiding cystourethrogram (VCUG) revealed unilateral reflux in robot group (n=1) and laparoscopic group (n=3).Four children received continuous antibiotic prophylaxis (CAP) for 3 months and reflux disappeared on VCUG re-examination.One case in robot group and 3 cases in laparoscopic group experienced acute postoperative urinary retention.After time of indwelling catheter was extended to 2 weeks,catheter was successfully removed without further urinary retention.Conclusion Single-port RALUR and LUR are both safe and effective for pediatric VUR.Single-port RALUR has a longer operative duration than LUR and yet less intraoperative hemorrhage and shorter hospitalization stay.Also incision of single-port RALUR is cosmetically superior and RALUR offers some value of clinical application.
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备注/Memo
收稿日期:2023-4-28。
基金项目:福建省卫健委科技计划项目(2021CXO1010125)
通讯作者:何少华,Email:cnfjhsh@163.com