Advantages of robot-assisted laparoscopy in the treatment of ureteroenteric anastomotic stricture: a comparative analysis with endoscopic balloon dilation
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摘要: 目的 比较机器人辅助腹腔镜输尿管膀胱再植术(robot-assisted laparoscopic ureteral reimplantation，RAUR)与内镜球囊扩张治疗根治性膀胱切除术后输尿管肠吻合口狭窄(ureteroenteric stricture，UES)的疗效。方法 回顾性分析2015年1月—2022年12月在浙江省人民医院行RAUR或内镜球囊扩张治疗UES的患者临床资料，共纳入RAUR组28例，球囊组16例；另有9例患者球囊扩张治疗失败，Ⅱ期行RAUR，单独成组为球囊后RAUR组。比较3组患者的手术时间、出血量、并发症发生率等围手术期指标及治疗成功率等。结果 3组患者的性别、年龄、狭窄长度、术前肾功能等一般资料比较差异无统计学意义(P>0.05)，具有可比性。RAUR组和球囊后RAUR组较球囊组手术时间延长(均P < 0.001)，出血量增多(P < 0.001，P=0.020)。RAUR组、球囊后RAUR组和球囊组的治疗成功率分别为92.86%、88.89%和62.50%，差异有统计学意义(P=0.031)。合并RAUR组的总成功率为91.89%，明显高于球囊组的62.50%(P=0.027)。3组术后Ⅱ级并发症发生率分别为10.71%、11.11%和6.25%，差异无统计学意义(P=0.872)。未发生Ⅲ级及以上并发症。结论 对于根治性膀胱切除术后UES，RAUR疗效确切，并发症可控。Abstract: Objective To compare the efficacy between robot-assisted laparoscopic ureteral reimplantation(RAUR) and endoscopic balloon dilation in treating benign ureteroenteric stricture(UES) after radical cystectomy.Methods A retrospective analysis was conducted on the clinical data of patients who underwent RAUR(28 cases) or balloon dilation(16 cases) for UES in Zhejiang Provincial People's Hospital from January 2015 to December 2022. Additionally, 9 patients underwent RAUR after failed balloon dilation. Perioperative indicators such as operation time, blood loss, complication rates, and treatment success rates were compared among the three groups.Results The baseline characteristics were comparable among the three groups(P>0.05). The operation time of the RAUR group and the balloon-then-RAUR group was longer than that of the balloon group(both P < 0.001), and blood loss was slightly higher(P < 0.001, P=0.020). The treatment success rates of the RAUR group, balloon-then-RAUR group, and balloon group were 92.86%, 88.89%, and 62.50%, respectively, with a statistically significant difference(P=0.031). The overall success rate of the combined two RAUR groups was 91.89%, significantly higher than that of the balloon group at 62.50%(P=0.027). The incidences of postoperative grade Ⅱ complications were 10.71%, 11.11%, and 6.25% respectively, with no statistically significant difference(P=0.872). No grade Ⅲ or higher complications occurred.Conclusion For UES after radical cystectomy for bladder cancer, RAUR has a definite efficacy and controllable complications.
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表 1 3组患者的一般资料比较
例(%)，X±S 项目 RAUR组(28例) 球囊组(16例) 球囊后RAUR组(9例) 统计量 P值 性别 χ2=1.27 0.530a) 男 21(75.0) 11(68.75) 8(88.89) 女 7(25.0) 5(31.25) 1(11.11) 年龄/岁 66.68±9.63 64.19±6.69 63.11±12.33 F=0.66 0.521b) RC方式 χ2=0.36 0.837a) 机器人 24(85.71) 13(81.25) 7(77.78) 腹腔镜 4(14.29) 3(18.75) 2(22.22) 输尿管狭窄长度/cm 1.46±0.41 1.56±0.37 1.62±0.45 F=0.65 0.525b) 输尿管狭窄侧别 χ2=0.84 0.657a) 单侧 22(78.57) 14(87.50) 8(88.89) 双侧 6(21.43) 2(12.50) 1(11.11) 术前肾功能/(μmol/L) 123.54±23.06 126.75±22.84 128.89±29.40 F=0.20 0.817b) 注：对3组间进行两两比较，a)性别、RC方式、狭窄侧别使用Fisher精确检验；b)年龄、狭窄长度和术前肾功能采用t检验；均差异无统计学意义(P>0.05)。 
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表 2 3组患者的手术相关资料及术后并发症
X±S 指标 合并RAUR组(37例) 球囊组(16例) 统计量1 P值1 统计量2 P值2 总体 RAUR组(28例) 球囊后RAUR组(9例) 手术时间/min 114.32±19.73 113.57±20.50 116.67±18.03 85.63±14.82 F=13.44 < 0.001a) F=27.12 < 0.001 出血量/mL 82.16±24.62 84.64±23.33 74.44±28.33 46.88±12.50 F=15.57 < 0.001a) F=29.35 < 0.001 Ⅱ级并发症发生率/% 10.81 10.71 11.11 6.25 χ2=0.27 0.872b) χ2=0.000 1 0.992 治疗成功率/% 91.89 92.86 88.89 62.5 χ2=6.92 0.031c) χ2=4.92 0.027 注：统计量1、P值1为RAUR组、球囊后RAUR组与球囊组3组比较；统计量2、P值2为合并RAUR组与球囊组2组比较。a)3组间两两比较，RAUR组和球囊后RAUR组较球囊组手术时间延长(均P < 0.001)，出血量增多(P < 0.001，P=0.020)；两RAUR组手术时间和出血量比较差异无统计学意义。b)对3组间就Ⅱ级并发症等分别行两两Fisher精确检验，均差异无统计学意义(P>0.05)。c)对3组间就治疗成功率分别行两两Fisher精确检验，RAUR组与球囊组比较差异有统计学意义(P=0.019)，RAUR组与球囊后RAUR组、球囊后RAUR组与球囊组比较，均差异无统计学意义(P>0.05)。
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