机器人辅助腹腔镜与开放、腹腔镜下膀胱根治性切除及Bricker回肠膀胱术比较分析  

Clinical analysis of robot-assisted laparoscopic,traditional laparoscopic and open radical cystectomy with Bricker ideal neobladder

作　　者：魏晓松[1] 庄乾元[1] 胡志全[1] 刘征[1] 王志华[1] 李凡[1] 杨欢[1] WANG Shao-gang 

机构地区：[1]华中科技大学附属同济医院泌尿外科,武汉430030

出　　处：《现代泌尿生殖肿瘤杂志》2016年第2期76-81,共6页Journal of Contemporary Urologic and Reproductive Oncology

摘　　要：目的比较分析机器人辅助腹腔镜、传统腹腔镜以及开放手术下膀胱根治性切除+Bricker回肠膀胱术的围手术期资料及并发症情况。方法入组2010年1月至2015年10月在我院行膀胱根治性切除+Bricker回肠代膀胱术的132例膀胱癌患者,其中行开放手术者69例,行腹腔镜手术者57例,行机器人辅助腹腔镜手术者6例,比较各组手术时间、术中出血量、输血量、进食时间、拔管时间及术后住院时间等围手术期情况和术后并发症。结果全部手术均顺利完成,3组患者的术后进食时间和盆腔引流管拨管时间比较无差异。开放组手术时间[398(360,450)min]低于腹腔镜组[435(390,510)min](P=0.011),而机器人组手术时间[338(330,480)min]与开放组和腹腔镜组之间无差异。机器人组出血量[300(200,375)ml]低于腹腔镜组[700(400,1 200)ml](P=0.043)和开放组[1 200(800,2 000)ml](P<0.001),腹腔镜组出血量低于开放组(P=0.003)。机器人组术中所输红细胞量(0U)低于开放组[6(4,7.5)U](P=0.001),与腹腔镜组[2(0,4)U]无差异,而腹腔镜组术中输红细胞量低于开放组(P<0.001)。术中输血浆量3组总体存在差异(P=0.040),但两两比较无差异。机器人组术后住院时间[11(10,19.5)d]少于开放组[19(14,23)d](P=0.027),腹腔镜组术后住院时间[15(13,20)d]与开放组及机器人组比较,均无差异。3组间肿瘤TNM分期、淋巴结阳性率及病理分级均无明显差异。3组患者间手术并发症比较,差异无统计学意义,以Clavien-Dindo评分对并发症进行分级,3组并发症分级无统计学差异。结论机器人辅助腹腔镜下根治性膀胱切除+Bricker回肠膀胱术具术中出血少、创伤小和术后恢复快的优势,是治疗浸润性膀胱癌安全有效的手术方法。Objective To compare the peri-operative data and postoperative complications of robot-assisted laparoscopic radical cystectomy(RARC),laparoscopic radical cystectomy(LRC)and open radical cystectomy(ORC). Methods A total of 132 cases underwent radical cystectomy with Bricker ideal neobladder during Jan 2010 to Oct 2015 were involved,and underwent ORC,LRC and RARC by 69,57 and 6cases respectively.The peri-operative status and postoperative complications of each group such as operating time,blood loss,transfusion volume,fasting time,extubation time,hospital stay after operation were compared. Results All operations were successfully completed.The fasting time and extubation time of the three groups were no significant difference(P<0.05).The operating time of open group was shorter than the laparoscopic group:398(360,450)mm vs 435(390,510)min(P=0.011),but there was no statistical difference in operating time between open group,laparoscopic and robot-assisted group.The blood loss in the robot-assisted group was lower than the laparoscopic group:300(200,375)ml vs 700(400,1 200)ml(P =0.043)and the open group:300(200,375)ml vs 1 200(800,2 000)ml(P<0.001),and the blood loss in laparoscopic group was lower than open group(P=0.003).The transfusion of RBC in robot-assisted group was lower than open group:0(0,0)U vs 6(4,7.5)U(P=0.001),but no statistical difference was found between laparoscopic group and robot-assisted group.The hospital stay after operation in robot-assisted group was shorter than open group:11(10,19.5)d vs 19(14,23)d(P=0.027),but no difference compared with laparoscopic group.TNM stage,lymph node positive rate and pathological grade of the three groups were no difference.There was no statistical difference in complication rates and grade(Clavien-Dindo)of the three groups. Conclusions RARC with Bricker ideal neobladder has the advantages of small trauma,little bleeding,and quick postoperative recovery,which is a safe,effective operative method for invasive bladder cancer.

关 键 词：机器人辅助腹腔镜手术 根治性膀胱切除术 Bricker回肠膀胱术 

分 类 号：R737.14[医药卫生—肿瘤]