机器人辅助腹腔镜下舌黏膜补片输尿管成形术治疗复杂输尿管狭窄疗效分析

Analysis of the Efficacy of Robot-Assisted Laparoscopic Lingual Mucosal Graft Ureteroplasty for the Treatment of Complex Ureteral Stricture

摘要: 目的：评估机器人辅助腹腔镜下舌黏膜补片输尿管成形术在治疗复杂输尿管狭窄中的安全性与临床疗效。方法：对2020年5月至2024年12月期间于安徽医科大学第一附属医院泌尿外科接受机器人辅助腹腔镜下舌黏膜补片输尿管成形术治疗输尿管狭窄的12例患者的病例资料进行回顾性分析，记录所纳入病例的手术过程信息、术后并发症及随访资料。其中，3例采用国产精锋手术机器人系统，9例采用进口达芬奇手术机器人系统。结果：12例手术均顺利完成，无中转开放手术，术中无严重并发症发生。两组患者的平均输尿管狭窄长度分别为(3.67 ± 0.58) cm和(4.22 ± 1.30) cm，平均手术时间分别为(359.33 ± 76.38) min和(338.00 ± 117.15) min，平均术中出血量分别为(36.67 ± 15.28) ml和(38.89 ± 19.65) ml，平均术区引流管留置时间分别为(4.33 ± 0.58)天和(4.44 ± 1.24)天，平均术后住院时间分别为6天和(7.00 ± 4.67)天，平均术后导尿管留置时间分别为14天和(12.22 ± 3.03)天。无Clavien-Dindo III级及以上并发症发生，术后2~3个月拔除输尿管支架，术后随访时间均超过12个月，末次随访时所有患者均达到临床成功标准，手术成功率为100%。结论：机器人辅助腹腔镜下舌黏膜补片输尿管成形术治疗复杂输尿管狭窄具有良好的安全性与临床可行性，但仍需通过更大样本研究和延长随访时间进一步验证。

Abstract: Objective: To evaluate the safety and clinical efficacy of robot-assisted laparoscopic lingual mucosal graft ureteroplasty in the treatment of complex ureteral stricture. Methods: A retrospective analysis was conducted on the case records of 12 patients who underwent robot-assisted laparoscopic lingual mucosal graft ureteroplasty for the treatment of ureteral stricture at the Department of Urology, the First Affiliated Hospital of Anhui Medical University from May 2020 to December 2024. The surgical procedure information, postoperative complications, and follow-up data of the included cases were recorded. Among them, 3 cases were treated with a domestic Jingfeng surgical robot system, and 9 cases were treated with an imported Da Vinci surgical robot system. Results: All 12 surgeries were successfully completed without conversion to open surgery, and no severe complications occurred during the operation. The average length of ureteral stricture in the two groups was (3.67 ± 0.58) cm and (4.22 ± 1.30) cm. The average operation time was (359.33 ± 76.38) min and (338.00 ± 117.15) min. The average intraoperative blood loss was (36.67 ± 15.28) ml and (38.89 ± 19.65) ml. The average postoperative drainage tube placement time was (4.33 ± 0.58) days and (4.44 ± 1.24) days. The average postoperative hospital stay was 6 days and (7.00 ± 4.67) days. The average postoperative catheter placement time was 14 days and (12.22 ± 3.03) days. No Clavien-Dindo grade III or higher complications occurred. The ureteral stents were removed 2~3 months postoperatively, and all patients achieved clinical success at the last follow-up, which was over 12 months. The surgical success rate was 100%. Conclusion: Robot-assisted laparoscopic lingual mucosal graft ureteroplasty for the treatment of complex ureteral stricture demonstrates good safety and clinical feasibility, but further verification through larger sample studies and extended follow-up periods is still needed.