机器人辅助腹腔镜结合吲哚菁绿荧光显影技术在复杂性输尿管狭窄修复重建中的应用
Application of robot-assisted laparoscopy combined with indocyanine green fluorescence imaging in the repair and reconstruction of complex ureteral stenosis
-
摘要: 目的 评价机器人辅助腹腔镜结合吲哚菁绿荧光显影技术治疗复杂性输尿管狭窄的有效性和安全性。方法 回顾性分析徐州医科大学附属医院2022年12月—2023年10月收治的13例复杂性输尿管狭窄患者的临床资料,所有患者均为内镜手术治疗结石后发生医源性输尿管狭窄,或输尿管狭窄手术治疗后再次发生狭窄。全部病例均经腹腔入路,吲哚菁绿溶液于术中通过肾造瘘管、输尿管支架或静脉通路注入患侧输尿管,利用彩色荧光模式辅助辨认输尿管狭窄段。6例行机器人辅助腹腔镜下输尿管狭窄段切除并端端吻合术,3例行机器人辅助腹腔镜下输尿管膀胱再植术,2例行机器人辅助腹腔镜下膀胱肌瓣输尿管成形术,1例行机器人辅助腹腔镜下舌黏膜输尿管成形术,1例行机器人辅助腹腔镜下输尿管阑尾补片修补术。结果 13例手术均成功完成,无术中和术后并发症,无中转开放手术,术中运用荧光显影技术,输尿管狭窄段及吻合端血运显影均良好,平均手术时间163(110~285)min,平均术中出血量40(20~110)mL,随访3~12个月,行腹部CT、静脉肾盂造影、彩超泌尿系检查,患者肾积水均明显减轻,无再狭窄发生。结论 机器人辅助腹腔镜治疗复杂性输尿管狭窄安全有效,吲哚菁绿荧光显影技术有助于精准定位输尿管狭窄段,明确血运情况,从而有效缩短手术时间,该技术操作简便、安全,值得推广。Abstract: Objective To evaluate the efficacy and safety of robot-assisted laparoscopy combined with indocyanine green fluorescence imaging in the treatment of complex ureteral strictures.Methods A total of 13 patients with complex ureteral strictures who were admitted to the Affiliated Hospital of Xuzhou Medical University from December 2022 to October 2023 were enrolled and their clinical data were retrospectively analyzed. All patients developed iatrogenic ureteral strictures following endoscopic surgery for stones or recurrent strictures after previous ureteral stricture surgeries. All cases were approached transabdominally, with indocyanine green solution injected into the affected ureter intraoperatively through a nephrostomy tube, ureteral stent, or intravenous route. The color fluorescence mode was used to assist in identifying the stenotic segment of the ureter. Six patients underwent robot-assisted laparoscopic ureteral stricture resection with end-to-end anastomosis, three patients underwent robot-assisted laparoscopic ureteral reimplantation, two patients underwent robot-assisted laparoscopic ureteral reconstruction with a bladder muscle flap, one patient underwent robot-assisted laparoscopic ureteroplasty using buccal mucosa, and one patient underwent robot-assisted laparoscopic ureteral repair with an appendiceal patch.Results All 13 surgeries were successfully completed without intraoperative or postoperative complications, and no conversion to open surgery was necessary. The use of fluorescence imaging during surgery demonstrated good blood supply at the stenotic segments and anastomotic sites. The average operative time was 163 (110-285) min, with an average intraoperative blood loss of 40 (20-110) mL. Follow-up ranged from 3 to 12 months, during which abdominal CT, intravenous pyelography, and urinary system ultrasound showed significant improvement in hydronephrosis in all patients, with no recurrence of strictures.Conclusions Robot-assisted laparoscopic treatment of complex ureteral strictures is safe and effective. Indocyanine green fluorescence imaging technology helps accurately locate the ureteral stricture segment and assess blood supply, thereby effectively shortening operative time. This technique is simple, safe, and worthy of promotion.