关键词: 机器人腹腔镜技术, 上尿路修复, 长段输尿管缺损, 结肠, 儿童

Abstract: Objective To investigate the clinical efficacy of robotic-assisted laparoscopic colonic ureter in the repair and reconstruction of the upper urinary tract in children.Methods We retrospectively analyze the clinical data of 20 children with long-segment ureteral defects who underwent robotic-assisted laparoscopic ureteral replacement surgery at The Seventh Medical Center of PLA General Hospital from July 2017 to June 2024.All children underwent preoperative examinations,including urinary system ultrasound,magnetic resonance urography,diuretic nephrolinoscintigraphy and voiding cystourethrography,while some patients underwent retrograde ureteral catheterization.All children were treated with robotic-assisted laparoscopic colonic ureteral replacement to repair the long-segment ureteral defects.Three different techniques were employed for the colonic replacement:8 cases used the Yang-Monti colonic ureteral replacement,8 cases used the pedicled colonic patch technique (Onlay technique),and 4 cases used the modified Yang-Monti colonic ureteral replacement.Postoperative complications were evaluated using the ClavienDindo grading system.Results All surgeries were successfully completed under robotic-assisted laparoscopy without severe intraoperative complications or conversion to traditional laparoscopic or open surgery.The average length of ureteral defect was (6.10±2.13)cm,the average operation time was (308.0±24.5) minutes,the average intraoperative blood loss was (52.5±27.5)ml,and the average time to start oral feeding was (5.35±0.75) days.The average indwelling time of the drainage tube after the operation was (5.8±1.0) days,and the average postoperative hospital stay was (9.3±1.63) days.Eight children developed Clavien Dindo Ⅰ-Ⅱ complications,all of which were managed conservatively.Three children experienced ClavienDindo Ⅲ complications,all due to double-J stent obstruction leading to increased hydronephrosis on the affected side,which resolved after stent replacement or nephrostomy.All children had their internal stents removed approximately 8 weeks postoperatively,and ipsilateral ureteroscopy was performed simultaneously.Among them,19 cases showed well-healed anastomoses with patent lumens,while 1 case exhibited localized roughness and partial adhesion of the replaced ureteral segment,which was treated with one session of balloon dilation.The mean follow-up duration was (42±17) months.Postoperative urinary system ultrasound showed reduced or stable hydronephrosis on the affected side compared to preoperative levels,and diuretic renal scintigraphy revealed varying degrees of improvement in renal function,with no significant obstruction.Conclusion Robotic-assisted laparoscopic colonic ureteral replacement is a safe and feasible approach for repairing long-segment ureteral strictures or defects in children.It provides a novel option for the ultimate treatment of complex upper urinary tract repair or reconstruction in children.

Key words: robot laparoscopic technology, upper urinary tract repair, long-segment ureteral defect, colon, children