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目的:介绍12例机器人辅助腹腔镜腰大肌悬吊法输尿管膀胱再植术的方法和疗效。方法:回顾性分析2013年6月~2015年3月收治的12例输尿管下段狭窄并肾积水患者的治疗经验。12例中左侧10例,右侧2例,术前B超、静脉肾盂造影提示输尿管下端狭窄,输尿管扩张平均直径1.8(0.6~2.6)cm、肾盂扩张分离平均2.56(1.3~3.9)cm。所有病例均在机器人辅助腹腔镜下完成,并辅助使用膀胱腰大肌悬吊技术,其中3例行黏膜下隧道法输尿管膀胱再植术,9例行输尿管膀胱乳头法吻合术。结果:12例手术均成功,无中转开放。平均手术时间131(80~185)min,其中机器人定位时间平均25min;平均出血量51(30~100)ml;术后引流管平均拔除时间为4.2(3~7)d,所有患者均无明显漏尿产生;术后尿管平均拔除时间为6.2(5~7)d,平均总住院时间7.8(5~9)d,术后双J管平均拔除时间为27.4(25~32)d。术后随访6~15个月,复查B超、静脉肾盂造影、膀胱造影,肾积水均明显减轻或消失,其中轻度肾积水2例,无明显肾积水10例,未见输尿管吻合口狭窄和输尿管反流。结论:机器人辅助腹腔镜腰大肌悬吊法输尿管膀胱再植术治疗输尿管下段狭窄安全可行、稳定可靠。
Objective: To introduce the method and curative effect of 12 cases of robot-assisted laparoscopic pyloroplasty suspension ureter bladder reconstruction. Methods: The clinical experience of 12 patients with ureteral stricture and hydronephrosis admitted from June 2013 to March 2015 were retrospectively analyzed. In the 12 cases, there were 10 cases on the left side and 2 cases on the right side. The preoperative ultrasonography and intravenous pyelography showed that the lower ureter was stenosed. The average diameter of ureteral dilatation was 1.8 (0.6-2.6) cm and the average length of pyeloplasty was 2.56 (1.3-3.9) cm. All cases were completed with robot-assisted laparoscopy and were assisted with bladder psoas suspension technique. Three cases underwent submucosal tunnel ureterocele replantation and nine cases underwent ureteric bladder nipple anastomosis. Results: All the 12 surgeries were successful without transit. The average operation time was 131 (80-185) min. The mean time of robot positioning was 25min and the average amount of bleeding was 51 (30-100) ml. The average drainage time after operation was 4.2 (3-7) d, and no significant difference was found between all patients The average time of catheter removal was 6.2 (5-7) days and the average length of stay was 7.8 (5-9) days. The mean duration of double J tube removal was 27.4 (25-32) d after operation. The patients were followed up for 6-15 months. The B ultrasound and intravenous pyelography, cystography and hydronephrosis were all significantly reduced or disappeared. There were 2 cases with mild hydronephrosis, 10 cases without obvious hydronephrosis and no ureteral anastomosis Stenosis and ureteral reflux. Conclusion: Robot-assisted laparoscopic psoas suspension ureter bladder replantation in the treatment of lower ureteral stricture safe and feasible, stable and reliable.