| 摘要: |
| 目的 总结机器人辅助腹腔镜根治性膀胱切除联合原位回肠新膀胱术治疗膀胱癌的临床经验，评估其疗效和安全性。方法 回顾性分析2019年1月至2019年12月接受机器人辅助腹腔镜根治性膀胱切除联合原位回肠新膀胱术治疗的膀胱癌患者的临床资料。共22例，均为男性，年龄为32~71岁（中位年龄63岁）。统计手术方法、手术时间、术后拔管时间、并发症等围手术期资料，术后病理结果，以及肿瘤控制情况和尿控效果等随访资料。结果 22例患者手术均顺利完成，无术中转开放手术者。其中4例行单孔手术，2例为全腔镜下原位回肠新膀胱术。手术时间为320~600（420±36）min，术中出血量为100~400（150±17）mL，围手术期均未输血。术后1~2 d（中位数2 d）下床活动，1~3 d（中位数2 d）恢复肠道通气，5~21 d（中位数10 d）拔除负压引流管，10~25 d（中位数14 d）拔除导尿管。本组患者均无术中肠道损伤、术后肠梗阻等肠道并发症，无切口感染。2例发生新膀胱漏尿，经延长留置导尿管后自行愈合。所有患者术后病理结果均为尿路上皮癌。术后随访3~15个月，未出现肿瘤复发，无患者死亡。术后2个月20例（90.1%）患者尿控满意。1例患者术后4个月因内疝而手术，2例患者术后6个月因排尿困难给予间歇自我导尿。结论 机器人辅助根治性膀胱切除联合原位回肠新膀胱术在临床上安全可行，短期肿瘤控制和尿控效果满意，远期疗效有待通过病例累积和长期随访进一步评估。 |
| 关键词: 机器人手术 腹腔镜技术 根治性膀胱切除术 原位回肠新膀胱术 |
| DOI：10.16781/j.0258-879x.2020.07.0731 |
| 投稿时间：2020-04-21修订日期：2020-06-19 |
| 基金项目: |
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| Robot-assisted laparoscopic radical cystectomy combined with orthotopic ileal neobladder in treating bladder cancer: a report of 22 cases |
| CHEN Ming,HUANG Jin-ming,WANG An-bang,WANG Zhi-jun,XU Dong-liang*,WANG Lin-hui |
(Department of Urology, Changzheng Hospital, Naval Medical University(Second Military Medical University), Shanghai 200003, China
*Corresponding author) |
| Abstract: |
| Objective To summarize our clinical experience on robot-assisted laparoscopic radical cystectomy combined with orthotopic ileal neobladder in treating bladder cancer, and to evaluate its efficacy and safety. Methods The clinical data of bladder cancer patients, who underwent robot-assisted radical cystectomy combined with orthotopic ileal neobladder from Jan. 2019 to Dec. 2019, were retrospectively analyzed. All the 22 cases were males, aged 32-71 years, with a median age of 63 years. The perioperative data such as operation approach, operation time, extubation time and complications, postoperative pathological results, and the follow-up data such as tumor control and urinary continence were all recorded. Results The operation was successfully performed in all the 22 patients, with no conversion to open surgery. Four cases underwent single-site operation, and two cases underwent full-endoscopic orthotopic ileal neobladder. The operation time was 320-600 min (mean [420±36] min) and the intraoperative blood loss was 100-400 mL (mean [150±17] mL) in the patients, with no blood transfusion during the perioperative period. After surgery, the patients resumed ambulation 1-2 days (median 2 days), recovered bowel function 1-3 days (median 2 days), removed the negative pressure drainage 5-21 days (median 10 days), and removed the urinary catheter 10-25 days (median 14 days) postoperatively. No patients had intestinal complications such as intraoperative intestinal injury or postoperative intestinal obstruction, and there was no incision infection. Neobladder leakage occurred in two cases and recovered spontaneously by prolonged indwelling urinary catheterization. The postoperative pathological results were urothelial carcinoma in all the patients. No tumor recurrence or death occurred during a follow-up of 3-15 months. Twenty patients (90.9%) were satisfied with urinary continence 2 months postoperatively. One patient underwent surgery for internal hernia 4 months postoperatively, and two patients were given intermittent self-catheterization due to dysuria 6 months postoperatively. Conclusion Robot-assisted radical cystectomy combined with orthotopic ileal neobladder is clinically safe and feasible, with satisfactory short-term tumor control and urinary continence. The long-term efficacy needs to be further evaluated by case accumulation and long-term follow-up. |
| Key words: robotic surgical procedures laparoscopy radical cystectomy orthotopic ileal neobladder |
