图 1 根据狭窄的位置选择不同的输尿管重建术式
图 2 近红外荧光成像技术联合认知融合三维图像导航技术应用于 RUR 手术中
[1] ZHAO LC. Management of Ureteral Strictures: NYU Case of the Month, October 2018 [J]. Rev Urol, 2018, 20 (4):177-178
[2] BILOTTA A, WIEGAND LR, HEINSIMER KR. Ureteral reconstruction for complex strictures: a review of the current literature [J]. Int Urol Nephrol, 2021, 53(11): 2211-2219
[3] SKUPIN PA, STOFFEL JT, MALAEB BS, et al. Robotic Versus Open Ureteroneocystostomy: Is There a Robotic Benefit [J]. J Endourol, 2020, 34(10): 1028-1032
[4] KOZINN SI, CANES D, SORCINI A, et al. Robotic versus open distal ureteral reconstruction and reimplantation for benign stricture disease [J]. J Endourol, 2012, 26(2): 147- 151
[5] ISAC W, KAOUK J, ALTUNRENDE F, et al. Robot- assisted ureteroneocystostomy: technique and comparative outcomes [J]. J Endourol, 2013, 27(3): 318-323
[6] STEIN RJ, TURNA B, PATEL NS, et al. Laparoscopic assisted ileal ureter: technique, outcomes and comparison to the open procedure [J]. J Urol, 2009, 182(3): 1032- 1039
[7] DING G, CHENG S, LI X, et al. Experience managing distal ureteral strictures with Boari flap- psoas hitch and comparison of open and laparoscopic procedures [J]. Transl Androl Urol, 2021, 10(1): 56-65
[8] LUCEREAU B, THAVEAU F, LEJAY A, et al. Learning Curve of Robotic- Assisted Anastomosis: Shorter than the Laparoscopic Technique? An Educational Study [J]. Ann Vasc Surg, 2016, 33: 39-44
[9] YANG K, FAN S, WANG J, et al. Robotic- assisted Lingual Mucosal Graft Ureteroplasty for the Repair of Complex Ureteral Strictures: Technique Description and the Medium- term Outcome [J]. Eur Urol, 2022, 81(5): 533- 540
[10] CARBONARA U, BRANCHE B, CISU T, et al. Robot- Assisted Ureteral Reimplantation: A Single- Center Comparative Study [J]. J Endourol, 2021, 35(10): 1504- 1511
[11] CHENG S, FAN S, WANG J, et al. Laparoscopic and robotic ureteroplasty using onlay flap or graft for the management of long proximal or middle ureteral strictures: our experience and strategy [J]. Int Urol Nephrol, 2021, 53(3): 479-488
[12] LEE Z, LEE M, KOSTER H, et al. A Multi-Institutional E xpe rience W ith R obo tic U re te roplas ty W ith B uccal Mucosa Graft: An Updated Analysis of Intermediate- Term Outcomes [J]. Urology, 2021, 147: 306-310
[13] ASGHAR AM, LEE Z, LEE RA, et al. Robotic Ureteral Reconstruction in Patients with Radiation- Induced Ureteral Strictures: Experience from the Collaborative of Reconstructive Robotic Ureteral Surgery [J]. J Endourol, 2021, 35(2): 144-150
[14] ZHANG Y, OUYANG W, XU H, et al. A Comparison of Robot- Assisted Laparoscopic Ureteral Reimplantation and Conventional Laparoscopic Ureteral Reimplantation for the Management of Benign Distal Ureteral Stricture [J]. Urol J, 2020, 17(3): 252-256
[15] ZHAO LC, WEINBERG AC, LEE Z, et al. Robotic Ureteral Reconstruction Using Buccal Mucosa Grafts: A Multi- institutional Experience [J]. Eur Urol, 2018, 73(3): 419-426
[16] YEE DS, SHANBERG AM. Robotic- assisted laparoscopic ureteroureterostomy in an adolescent with an obstructed upper pole system and crossed renal ectopia with fusion [J]. Urology, 2006, 68(3): 673. e5-e7
[17] SUN G, YAN L, OUYANG W, et al. Management for Ureteral Stenosis: A Comparison of Robot- Assisted Laparoscopic Ureteroureterostomy and Conventional Laparoscopic Ureteroureterostomy [J]. J Laparoendosc Adv Surg Tech A, 2019, 29(9): 1111-1115
[18] WANG Q, LU Y, HU H, et al. Management of recurrent ureteral stricture: a retrospectively comparative study with robot- assisted laparoscopic surgery versus open approach [J]. PeerJ, 2019, 7: e8166
[19] PATEL V. R obo tic- assis ted lapa roscopic dism embe red pyeloplasty [J]. Urology, 2005, 66(1): 45-49
[20] SCHWENTNER C, PELZER A, NEURURER R, et al. Robotic Anderson- Hynes pyeloplasty: 5- year experience of one centre [J]. BJU Int, 2007, 100(4): 880-885
[21] MUFARRIJ PW, WOODS M, SHAH OD, et al. Robotic dismembered pyeloplasty: a 6- year, multi- institutional experience [J]. J Urol, 2008, 180(4): 1391-1396
[22] NAUDE JH. Buccal mucosal grafts in the treatment of ureteric lesions [J]. BJU Int,1999, 83(7): 751-754
[23] ZHAO LC, YAMAGUCHI Y, BRYK DJ, et al. RobotAssisted Ureteral Reconstruction Using Buccal Mucosa [J]. Urology, 2015, 86(3): 634-638
[24] LEE Z, WALDORF BT, CHO EY, et al. Robotic Ureteroplasty with Buccal Mucosa Graft for the Management of Complex Ureteral Strictures [J]. J Urol, 2017, 198(6): 1430-1435
[25] LI B, XU Y, HAI B, et al. Laparoscopic onlay lingual mucosal graft ureteroplasty for proximal ureteral stricture: initial experience and 9- month follow- up [J]. Int Urol Nephrol, 2016, 48(8): 1275-1279
[26] LIANG C, WANG J, HAI B, et al. Lingual Mucosal Graft Ureteroplasty for Long Proximal Ureteral Stricture: 6 Years of Experience with 41 Cases [J]. Eur Urol, 2022, 82(2):193-200
[27] CHENG S, LI X, YANG K, et al. Modified Laparoscopic and Robotic Flap Pyeloplasty for Recurrent Ureteropelvic Junction Obstruction with a Long Proximal Ureteral Stricture: The "Wishbone" Anastomosis and the "Ureteral Plate" Technique [J]. Urol Int, 2021, 105(7-8): 642-649
[28] WANG J, XIONG S, FAN S, et al. Appendiceal Onlay Flap Ureteroplasty for the Treatment of Complex Ureteral Strictures: Initial Experience of Nine Patients [J]. J Endourol, 2020, 34(8): 874-881
[29] REGGIO E, RICHSTONE L, OKEKE Z, et al. Laparoscopic ureteroplasty using on-lay appendix graft [J]. Urology, 2009, 73(4): 928.e7-e10
[30] DUTY BD, KRESHOVER JE, RICHSTONE L, et al. Review of appendiceal onlay flap in the management of complex ureteric strictures in six patients [J]. BJU Int, 2015, 115(2): 282-287
[31] ELBERS JR, RODRIGUEZ SOCARRAS M, RIVAS JG, et al. Robotic Repair of Ureteral Strictures: Techniques and Review [J]. Curr Urol Rep, 2021, 22(8): 39
[32] LEE M, LEE Z, METRO MJ, et al. Robotic Ureteral Bypass Surgery with Appendiceal Graft for Management of Long- Segment Radiation- Induced Distal Ureteral Strictures: A Case Series [J]. J Endourol Case Rep, 2020, 6(4): 305- 309
[33] GILL IS, SAVAGE SJ, SENAGORE AJ, et al. Laparoscopic ileal ureter [J]. J Urol, 2000, 163(4): 1199-1202
[34] WAGNER JR, SCHIMPF MO, COHEN JL. Robot- assisted laparoscopic ileal ureter [J]. JSLS, 2008, 12(3): 306-309
[35] BRANDAO LF, AUTORINO R, ZARGAR H, et al. Robotic ileal ureter: a completely intracorporeal technique [J]. Urology, 2014, 83(4): 951-954
[36] FAN S, HAN G, LI Z, et al. Robot- assisted laparoscopic ileal ureter replacement with extracorporeal ileal segment preparation for long ureteral strictures: a case series [J]. BMC Surg, 2022, 22(1): 435
[37] LI X, WANG X, CHEN S, et al. Robot- assisted Laparoscopic Bilateral Ileal Ureter in Duplex Ureter With Strictures After Treatment Failure of Allium Stents [J]. Urology, 2022, 169: 267-268
[38] ZHU W, XIONG S, FANG D, et al. Minimally invasive ileal ureter replacement: Comparative analysis of robot- assisted laparoscopic versus conventional laparoscopic surgery [J]. Int J Med Robot, 2021, 17(3): e2230
[39] BREDA A, DIANA P, TERRITO A, et al. Intracorporeal Versus Extracorporeal Robot- assisted Kidney Autotransplantation: Experience of the ERUS RAKT Working Group [J]. Eur Urol, 2022, 81(2): 168-175.
暂无相关信息!
输尿管狭窄疾病分为良性和恶性,其中,良性 输尿管狭窄主要包括先天性输尿管狭窄以及泌尿系 结石、医源性损伤、外伤、放疗和缺血引起的后天
性输尿管狭窄。良性输尿管狭窄治疗的目的是疏通 输尿管管腔、缓解症状,并预防肾功能损害。治疗 方案主要包括内镜治疗和手术重建。当输尿管狭窄
难以通过内镜处理时,可进行手术重建[1-2] 。 输尿管重建手术的路径通常分为开放、腹腔镜 和机器人手术[1- 2]
。手术技术主要包括切除及吻合, 使用自体移植物,或带蒂的自体瓣,以及完全替代 或自体肾移植,使用不同的技术取决于输尿管狭窄 的位置和长度 (图
1)。 开放手术往往存在切口较大、出血较多、术后 疼痛剧烈和住院时间长等缺点[3-5] 。虽然腹腔镜手术
是一种替代选择,可提供与开放手术类似的治疗结 果和较少的围术期并发症及更短的住院时长[6-7] ,但 其学习曲线较长,初学者不宜掌握[8]
。相较前两者而 言,机器人辅助腹腔镜手术具有独特的优势,可在v> 狭小的空间进行复杂而精细的操作,而且学习曲线 较短[8]
,许多研究报道机器人输尿管重建 (robotic ureteral reconstruction,RUR) 是一种安全有效的输
尿管修复手段,手术成功率高,并发症发生率低[9-15] 。 然而,既往许多关于 RUR的数据报道通常样本 量小、随访时间短。近 5年来,关于
RUR 的研究较 多,患者样本量增大,随访时间较长[3-5,7,9-15] 。本文 重点回顾 RUR 治疗输尿管良性狭窄的手术技术、并
发症和结果,以供临床医生参考。
1 RUR 的修复策略
2 RUR的常见术式
2.1机器人输尿管—输尿管吻合术
2.2机器人肾盂成形术
2.3机器人颊黏膜输尿管成形术
2.4机器人舌黏膜输尿管成形术
2.5机器人肾盂瓣技术
2.6机器人阑尾补片技术
2.7机器人阑尾管状替代技术
2.8机器人输尿管膀胱再植术
2.9机器人回肠代输尿管术
2.10机器人辅助自体肾移植术
3 小结及展望
随着机器人手术系统的进一步普及,RUR已逐步成为输尿管修复与重建领域的重要手段。本文结合文献回顾和笔者中心经验,对RUR治疗输尿管狭窄的现状进行了总结。目前RUR的大多数研究为个案或病例系列报道,未针对RUR进行系统性综述及分析,因而缺乏有力的循证医学证据。
总的来说,RUR目前已成为治疗成人输尿管狭窄的一种有效手段,相较于开放及腹腔镜手术,RUR具有较少的手术时间和术中出血等优势。然而,现阶段RUR技术主要在三级医学中心开展,许多关于RUR的研究来自单中心,且受限于小样本和较短随访时长的影响,尚未形成等级较高的临床证据,仍需针对RUR的大样本、多中心、随访时长的研究。加之输尿管修复手术种类繁多、技术较复杂、手术机器人尚未普及等,RUR的标准化推广短期内仍存一定难度。未来随着手术机器人的进一步普及,RUR技术将会进一步惠及更多的输尿管狭窄患者。
暂无相关信息!
暂无相关信息!