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目的:总结解放军总医院泌尿外科应用机器人辅助腹腔镜技术同期治疗肾盂输尿管连接部狭窄(UPJO)及继发结石病例的临床经验。方法:回顾性分析2014年3月~2016年3月应用达芬奇机器人实施的18例经腹腔途径行机器人辅助腹腔镜肾盂成形术同期行肾盂探查取石术的临床资料。结果:18例肾盂成形术及肾盂探查取石术均同期完成,无残余结石,无副损伤及中转开放。其中左侧12例,右侧6例,所有病例均术前通过静脉肾盂造影及CT检查明确为肾盂输尿管连接部梗阻且合并继发结石,积水为中到重度,结石1~3块,大小1~3cm,手术时间60~110min,平均(80±14)min,术中出血量10~20ml,术中均未输血,结石均完整取出,术后1例出现吻合口漏尿,给予充分引流后于术后10天吻合口愈合,余17例恢复顺利,术后5~10天拔除引流管,术后住院日6~10d,平均6.3d,所有病例均获得随访6~30个月,随访期内肾积水无明显加重,结石无复发。结论:机器人辅助腹腔镜技术治疗UPJO合并继发结石安全可行,可同期行肾盂成形术及结石取出,具有创伤小,出血少,高清成像视野清晰,机械手臂操作精细,肾盂裁剪精准,对位缝合精确等优点。因机械手臂可弯曲,可同期行肾盂肾盏探查取出继发结石,减少患者二次手术风险,术后恢复快。对UPJO合并结石的患者,机器人辅助腹腔镜技术是较好选择。
OBJECTIVE: To summarize the clinical experience of concurrent use of robot-assisted laparoscopy in the treatment of ureteropelvic junction stenosis (UPJO) and secondary stones in Department of Urology, PLA General Hospital. Methods: The clinical data of 18 patients undergoing laparoscopic pyeloplasty assisted by Da Vinci robot during the same period from March 2014 to March 2016 undergoing pyreolithography were retrospectively analyzed. Results: 18 cases of pyeloplasty and pelvis exploration lithotomy were completed at the same period, no residual stones, no side effects and transit open. Including the left side of the 12 cases, the right side of the 6 cases, all cases were preoperative intravenous pyelography and CT examination clearly ureteropelvic junction obstruction and secondary stones, hydrocephalus is moderate to severe, stones 1 to 3, size 1 ~ 3cm, operation time 60 ~ 110min, average (80 ± 14) min, intraoperative blood loss 10 ~ 20ml, no blood transfusion during surgery, stones were completely removed, 1 case of postoperative anastomotic leakage, given adequate drainage After 10 days after operation, the anastomotic healed, and the other 17 cases recovered smoothly. The drainage tube was removed 5 to 10 days after operation. The postoperative hospital stay was 6 to 10 days, with an average of 6.3 days. All cases were followed up for 6 to 30 months. No significant increase in hydronephrosis during the period, no recurrence of stones. Conclusions: The robot-assisted laparoscopic technique for the treatment of UPJO combined with secondary stone is safe and feasible, and can be performed with pyeloplasty and stone removal in the same period. It has the advantages of less trauma, less bleeding, clear imaging horizons, fine mechanical arm operation, precise renal pelvis incision, Accurate and so on. Due to the flexible arm can be performed concurrent pyelonephrodite exploration to remove secondary stones, reduce the risk of secondary surgery in patients with postoperative recovery fast. For patients with UPJO complicated with stones, robotic assisted laparoscopy is a better choice.