Initial experience of robot-assisted laparoscopic augmentation ileocystoplasty in treatment of tuberculous bladder contracture
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摘要: 因泌尿系结核进展导致的膀胱挛缩常引起尿频、尿急、尿痛,可伴血尿或脓尿,严重者可合并对侧肾积水及肾功能不全,甚至可能危及生命。药物保守治疗往往效果不佳,膀胱扩大术是主要的治疗手段。传统开放手术和腹腔镜手术均取得不错的效果,近年来,机器人平台的出现为术者提供了三维立体视野、更加精细灵活的机械臂,很大程度方便了腔内游离缝合等操作。2019年4月~2019年12月共有3例患者因结核性膀胱挛缩于我中心行机器人辅助腹腔镜回肠膀胱扩大术,男2例,女1例,术前泌尿系超声提示膀胱容量分别为35 mL、78 mL、9.2 mL。3例患者均成功完成机器人辅助腹腔镜回肠膀胱扩大术,无中转开放或普通腹腔镜手术,中位手术时间240(221~273) min,中位术中出血量100(50~200) mL。中位术后住院时间8(6~10) d。术后随访5~13个月,膀胱容量300~450 mL,膀胱顺应性良好,3例患者均经尿道自主排尿,最大尿流率15.6~19.1 mL/s,残余尿0~50 mL。随访期间无结核复发、肾功能不全等并发症发生。综上,我中心初步经验表明机器人回肠膀胱扩大术能有效增加膀胱容量,改善膀胱挛缩引起的尿频、尿急等症状,提高生活质量。在术前积极抗结核治疗、合理选择病例和术后严格管理下,机器人辅助腹腔镜回肠膀胱扩大术是治疗结核性膀胱挛缩的一种有效、较理想的方法,值得临床推广应用。Abstract: Tuberculous bladder contracture often causes frequent urination, urgency, dysuria, hematuria or pyuria. In severe cases, it may be complicated with contralateral hydronephrosis and renal insufficiency, and may even be life-threatening. Conservative treatment is often ineffective, and augmentation cystoplasty is the main treatment. Both traditional open surgery and laparoscopic surgery have achieved good results. In recent years, the emergence of robot platforms has provided the surgeon with a three-dimensional stereoscopic field of view and a more elaborate robotic arm, which greatly facilitates surgical operations. From April 2019 to December 2019, there were 3 patients who underwent robot-assisted laparoscopic augmentation ileocystoplasty for bladder contracture in our center, including 2 males and 1 female. Preoperative urinary ultrasound showed that the bladder volume was 35 mL, 78 mL, and 9.2 mL, respectively. All 3 patients were successfully completed robot-assisted laparoscopic augmentation ileocystoplasty without conversion. The median operation time was 240(221-273) min, and the median intraoperative blood loss was 100(50-200) mL. The median postoperative hospital stay was 8(6-10) days. After 5-13 months of follow-up period, the bladder volume was 300-450 mL, and the bladder compliance was good. All 3 patients can urinate autonomously. The maximum urine flow rate ranged from 15.6 mL/s to 19.1 mL/s. The residual urine ranged from 0 to 50 mL. No complications occurred during the follow-up period. In summary, the initial experience of our center shows that robot-assisted laparoscopic augmentation ileocystoplasty can effectively increase bladder capacity, relieve symptoms and improve quality of life. Under anti-tuberculosis treatment before surgery, reasonable selection of cases, and strict postoperative management, robot-assisted laparoscopic augmentation ileocystoplasty can be an effective and ideal method for the treatment of tuberculous bladder contracture.
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Key words:
- urinary tuberculosis /
- bladder contracture /
- bladder augmentation /
- robotic surgery
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