机器人辅助腔镜技术处理泌尿系统疾病：单中心600例报道  

The robotic-assisted laparoscopic surgery treating urological diseases： experiences of 600 cases in a single medical center

作　　者：夏丹[1] 来翀[1] 王平[1] 景泰乐[1] 叶孙益[1] 秦杰[1] 孔德波[1] 汪朔[1] 

机构地区：[1]浙江大学医学院附属第一医院,杭州310003

出　　处：《中华泌尿外科杂志》2016年第6期403-406,共4页Chinese Journal of Urology

基　　金：浙江省医药卫生科技计划项目课题（2016142965）

摘　　要：目的 总结单中心机器人辅助泌尿外科手术的临床资料,提高对机器人技术在泌尿系疾病处理中的认识.方法 回顾性分析2014年9月至2015年11月本中心600例应用da Vinci手术机器人系统进行泌尿外科手术的临床资料.男473例,女127例.年龄17 ～ 82岁,平均（67.2±6.8）岁.对病例的分布、手术方式、围术期和术后情况进行总结.结果 600例机器人辅助腹腔镜手术均顺利完成,无中转开放手术.其中根治性前列腺切除术304例,肾癌手术185例（包括根治性肾切除术9例,肾部分切除术174例,根治性肾切除术＋腔静脉取癌栓术2例）,肾盂输尿管离断成形术27例,根治性膀胱切除术12例（包括Bricker膀胱术11例,Studer原位新膀胱术1例）,其他手术共72例（包括肾上腺切除术、腹膜后肿瘤切除术、腹膜后淋巴清扫术、腔静脉后输尿管成形术、左肾静脉移位吻合术等）.117例（19.5％）患者术后出现并发症,无一例死亡.对根治性前列腺切除术和肾部分切除术重点进行了经腹腔和经腹膜后两种手术入路的比较.经腹膜后途径与经腹腔途径相比并不增加住院时间和切缘阳性率（P＞O.05）.结论 da Vinci机器人手术系统在泌尿系疾病处理中应用广泛,尤其适用于需要腔内缝合及在狭小空间内操作的手术类型.经腹膜后途径行根治性前列腺切除术和肾部分切除术安全、可行.Objective To analyze and summarize the clinical data of 600 robotic-assisted urological surgeries at a single center,aiming to acquire a better understanding of the robotic techniques and emphasize its role in treating urological diseases.Methods Six hundred patients with urological diseases underwent robotic-assisted laparoscopic surgeries from September 2014 to November 2015,including 473 males and 127 females with a mean age of （67.2 ± 6.8） years.The disease categary,surgical procedure selection,intraand post-operative data and short-term follow-up were reviewed and statistically compared.Results All 600 surgeries were performed successfully by the da Vinci system,and none of which was converted to the hand-assisted procedure.Three hundred and four radical prostatectomy and 185 renal surgeries were performed,including 9 radical nephrectomy,174 partial nephrectomy,2 radical nephrectomy plus vena cava thrombus removal.Pyeloplasties for ureteropelvic junction were performed in 27 cases.Radical cystectomy was performed in 12 patients,11 of which underwent Bricker conduit,while one patient underwent Studer ileal neobladder.Other surgeries,including adrenalectomy,resection of retroperitoneal tumor,retroperitoneal lymphadectomy,retrocaval ureteral angioplasty,transportation of the left renal vein,were performed in 72 patients.Complications occured in 117patients （19.5%）.No patient died of surgery.Intra-peritoneal and extra-peritoneal approach of radical prostatectomy and partial nephrectomy were compared in details.The extra-peritoneal approach neither prolonged the hospital stay after the operation nor increased the incidence of positive margin （P 〉 0.05）.Conclusions The da Vinci robotic system can be widely used to treat urological diseases,particularly in surgeries requiring suture in a small cavity.Our experiences offer an encouraging experiences on robotic peritoneal surgeries.Extraperitoneal radical prostatectomy and partial nephrectomy are safe and applicable,offering another minimally invasive

关 键 词：机器人辅助腹腔镜 微创泌尿外科 根治性前列腺切除术 根治性肾切除术 经腹膜后途径 

分 类 号：R699[医药卫生—泌尿科学] TP242[医药卫生—外科学]