中华泌尿外科杂志
中華泌尿外科雜誌
중화비뇨외과잡지
Chinese Journal of Urology
2015年
11期
842-846
,共5页
张祥%许天源%王晓晶%夏磊磊%秦亮%王先进%邵远%沈周俊
張祥%許天源%王曉晶%夏磊磊%秦亮%王先進%邵遠%瀋週俊
장상%허천원%왕효정%하뢰뢰%진량%왕선진%소원%침주준
复杂性肾结石%机器人辅助腹腔镜%铸型结石
複雜性腎結石%機器人輔助腹腔鏡%鑄型結石
복잡성신결석%궤기인보조복강경%주형결석
Complex nephrolithiasis%Robot-assisted laparoscopic surgery%Staghorn calculi
目的 探讨机器人辅助腹腔镜手术治疗肾铸型结石等复杂性结石的临床疗效及安全性.方法 回顾性分析2010年3月至2015年1月收治的31例复杂性肾结石患者的临床资料,男20例,女11例.年龄26～73岁,平均47岁.16例结石位于肾下盏同时伴有输尿管结石,其中7例伴有肾盂输尿管连接处梗阻(UPJO),且盏部结石离输尿管连接处较远;9例为双肾多发结石;3例为肾铸型结石;3例为先天性重复肾伴肾盂肾盏结石.结石最大径15 ～ 78 mm,平均33 mm.术前超声检查示19例伴有明显的肾盂分离,大小12 ～ 62 mm,平均33 mm.术前血肌酐96.8 ～ 284.5 μmol/L,平均172.4 μmol/L.3例铸型结石患者术前患侧肾小球滤过率为18.5 ～ 30.4 ml/min,平均23.8 ml/min.31例均行经腹腔途径机器人辅助腹腔镜手术治疗,包括机器人辅助腹腔镜下切开取石术+肾盂输尿管成形术、机器人辅助腹腔镜下肾实质切开取石术和机器人辅助腹腔镜下肾盂切开取石术+重复肾成形术.结果 本组31例手术均顺利完成,无中转开放手术.手术时间(达芬奇机器人控制台所记录时间)45 ～128 min,平均64 min.术中出血量10 ～400 ml,平均80 ml.术后住院时间4～11d,平均6d.术后引流量20 ～180 ml,平均60 ml.引流管拔除时间2～7d,平均4d.导尿管拔除时间3～8d,平均5d.术后未出现气胸、肠道损伤、尿源性脓毒血症或高热等严重并发症.7例伴UPJO者术后利尿性肾图检查结果示梗阻得到明显改善或完全治愈.随访时间2 ～ 27个月,平均7个月.复查腹部X线片示29例手术侧无结石残留;2例有结石残留,结石最大径平均为4.2 mm,上尿路通畅,无积水,术后3个月行体外冲击波碎石术治愈.本组31例均于术后1个月随访,血肌酐88.4 ～ 126.5μmol/L,平均96.5 μmol/L;3例铸型结石患者手术侧肾小球滤过率36.5 ～ 45.7 ml/min,平均41.3ml/min.结论 机器人辅助腹腔镜手术可作为铸型结石等复杂性肾结石患者较优的可选手术方式.
目的 探討機器人輔助腹腔鏡手術治療腎鑄型結石等複雜性結石的臨床療效及安全性.方法 迴顧性分析2010年3月至2015年1月收治的31例複雜性腎結石患者的臨床資料,男20例,女11例.年齡26～73歲,平均47歲.16例結石位于腎下盞同時伴有輸尿管結石,其中7例伴有腎盂輸尿管連接處梗阻(UPJO),且盞部結石離輸尿管連接處較遠;9例為雙腎多髮結石;3例為腎鑄型結石;3例為先天性重複腎伴腎盂腎盞結石.結石最大徑15 ～ 78 mm,平均33 mm.術前超聲檢查示19例伴有明顯的腎盂分離,大小12 ～ 62 mm,平均33 mm.術前血肌酐96.8 ～ 284.5 μmol/L,平均172.4 μmol/L.3例鑄型結石患者術前患側腎小毬濾過率為18.5 ～ 30.4 ml/min,平均23.8 ml/min.31例均行經腹腔途徑機器人輔助腹腔鏡手術治療,包括機器人輔助腹腔鏡下切開取石術+腎盂輸尿管成形術、機器人輔助腹腔鏡下腎實質切開取石術和機器人輔助腹腔鏡下腎盂切開取石術+重複腎成形術.結果 本組31例手術均順利完成,無中轉開放手術.手術時間(達芬奇機器人控製檯所記錄時間)45 ～128 min,平均64 min.術中齣血量10 ～400 ml,平均80 ml.術後住院時間4～11d,平均6d.術後引流量20 ～180 ml,平均60 ml.引流管拔除時間2～7d,平均4d.導尿管拔除時間3～8d,平均5d.術後未齣現氣胸、腸道損傷、尿源性膿毒血癥或高熱等嚴重併髮癥.7例伴UPJO者術後利尿性腎圖檢查結果示梗阻得到明顯改善或完全治愈.隨訪時間2 ～ 27箇月,平均7箇月.複查腹部X線片示29例手術側無結石殘留;2例有結石殘留,結石最大徑平均為4.2 mm,上尿路通暢,無積水,術後3箇月行體外遲擊波碎石術治愈.本組31例均于術後1箇月隨訪,血肌酐88.4 ～ 126.5μmol/L,平均96.5 μmol/L;3例鑄型結石患者手術側腎小毬濾過率36.5 ～ 45.7 ml/min,平均41.3ml/min.結論 機器人輔助腹腔鏡手術可作為鑄型結石等複雜性腎結石患者較優的可選手術方式.
목적 탐토궤기인보조복강경수술치료신주형결석등복잡성결석적림상료효급안전성.방법 회고성분석2010년3월지2015년1월수치적31례복잡성신결석환자적림상자료,남20례,녀11례.년령26～73세,평균47세.16례결석위우신하잔동시반유수뇨관결석,기중7례반유신우수뇨관련접처경조(UPJO),차잔부결석리수뇨관련접처교원;9례위쌍신다발결석;3례위신주형결석;3례위선천성중복신반신우신잔결석.결석최대경15 ～ 78 mm,평균33 mm.술전초성검사시19례반유명현적신우분리,대소12 ～ 62 mm,평균33 mm.술전혈기항96.8 ～ 284.5 μmol/L,평균172.4 μmol/L.3례주형결석환자술전환측신소구려과솔위18.5 ～ 30.4 ml/min,평균23.8 ml/min.31례균행경복강도경궤기인보조복강경수술치료,포괄궤기인보조복강경하절개취석술+신우수뇨관성형술、궤기인보조복강경하신실질절개취석술화궤기인보조복강경하신우절개취석술+중복신성형술.결과 본조31례수술균순리완성,무중전개방수술.수술시간(체분기궤기인공제태소기록시간)45 ～128 min,평균64 min.술중출혈량10 ～400 ml,평균80 ml.술후주원시간4～11d,평균6d.술후인류량20 ～180 ml,평균60 ml.인류관발제시간2～7d,평균4d.도뇨관발제시간3～8d,평균5d.술후미출현기흉、장도손상、뇨원성농독혈증혹고열등엄중병발증.7례반UPJO자술후이뇨성신도검사결과시경조득도명현개선혹완전치유.수방시간2 ～ 27개월,평균7개월.복사복부X선편시29례수술측무결석잔류;2례유결석잔류,결석최대경평균위4.2 mm,상뇨로통창,무적수,술후3개월행체외충격파쇄석술치유.본조31례균우술후1개월수방,혈기항88.4 ～ 126.5μmol/L,평균96.5 μmol/L;3례주형결석환자수술측신소구려과솔36.5 ～ 45.7 ml/min,평균41.3ml/min.결론 궤기인보조복강경수술가작위주형결석등복잡성신결석환자교우적가선수술방식.
Objective To investigate the clinical efficacy and safety of robot-assisted laparoscopic surgery for the treatment of complex nephrolithiasis.Methods The retrospective analysis of 31 cases of robot-assisted laparoscopic surgery for the treatment of complex nephrolithiasis was carried out.20 of these patients were male,while the others were female.The average age of these patients was 47 years, ranged from 26-73.Sixteen patients had calculi located both in subrenal calyx and ureter, 7 cases of them had ureteropelvic junction obstruction while the subrenal calyx calculus were far away from ureteropelvic junction.Out of the total 31 cases, 9 were multiple renal calculi, 3 were staghorn calculi, 3 were congenital renal malformation with staghorn calculi.The average diameter of calculi was 33 mm, ranged from 15 to 78.19 cases had obvious pelvic separation presented by pre-operative ultrasonography, average 33 mm, ranged from 12 to 62 mm.All the cases were performed by robot-assisted laparoscopic surgery transperitoneally.Results All operations were successful without converting to laparoscopy or open surgery.The average operative time (robotic console time) was 64 min, ranged from 45 to 128 min.The average estimated blood loss during operation was 80 ml, ranged from 10-400 ml.The length of post-operative hospital stay were 4-11 days, average 6 days.The average removal time of drainage was 4 days, ranged from 2 to 7 days.There was no severe complications after operation.The diuretic renogram showed that the obstruction in patients with UPJO was cured or significantly improved.The average follow-up time was 7 months (ranged from 2 to 27 months).Post-operative KUB X-ray showed no residual calculi in 29 patients.The average value of serum creatinine (Cr) was 96.5 μmol/L (ranged from 88.4 to 126.5 μmol/L) in one month post-operative follow-up.The glomerular filtration rates of affected side recovered to 36.5-45.7 ml/min, average 41.3 ml/min, in those 3 patients who had staghorn calculi.Conclusion Robot-assisted laparoscopic surgery may provide an excellent alternative option in the treatment of complex nephrolithiasis.
