机器人辅助根治性膀胱切除术的临床研究  

Clinical analysis for undergoing robotic assisted radical cystectomy

作　　者：刘安伟[1] 贾高臻 陈新[1] 徐伟东[1] 吕晨[1] 曾蜀雄[1] 张振声[1] 杨波[1] 高旭[1] 孙颖浩[1] 许传亮[1] 

机构地区：[1]第二军医大学附属长海医院泌尿外科,上海200433

出　　处：《中华泌尿外科杂志》2016年第9期667-671,共5页Chinese Journal of Urology

基　　金：国家自然科学基金（81572509）

摘　　要：目的：总结机器人辅助根治性膀胱切除术（ robotic assisted radical cystectomy，RARC）的手术经验，评估其安全性及可行性。方法回顾性分析2013年1月至2015年12月收治的35例膀胱癌患者的临床资料，男34例，女性1例。年龄46岁～78岁，中位年龄65岁。35例均行RARC，其中行输尿管皮肤造口2例，回肠膀胱26例，原位新膀胱7例。记录手术时间、出血量、输血率、术后通气时间、术后住院时间、围手术期并发症、复发时间、死亡时间及死亡原因等临床指标。结果本组35例手术均顺利完成，无中转开放手术。手术时间分别为：输尿管皮肤造口（315．0±106．1） min，回肠膀胱（443．2±93．2）min，原位新膀胱（488．3±80．6） min。出血量为100～500 ml，平均（260．0±108．6）ml，其中5例术中输红细胞悬液400 ml，输血率为14．2％。术后通气时间1～7 d，平均（3．1±1．6）d。胃管拔除时间2～10d，平均（4．2±2．2）d。引流管拔除时间4～25 d，平均（10．8±5．1）d。术后住院时间6～25 d，平均（12．4±5．2）d。术后病理分期：＜T2期17例，T2期8例，T3期10例；N0期31例，N1～2期4例；均无远处转移。术后并发症：麻痹性肠梗阻4例，淋巴漏5例，给予留置胃肠减压管、补充白蛋白等治疗后治愈。随访4～46个月，平均16．6个月，远处转移复发4例，死亡3例，术后1年的总生存率为89．5％，无复发生存率为95．7％，疾病特异性生存率为95．7％。结论根据初期手术经验及手术疗效，我们认为RARC具有创伤小、术后恢复快及并发症发生率低等特点，是一种安全可行的手术方式。Objective To summarize the surgical experience and primary follow-up results for robotic assisted radical cystectomy （ RARC ） , as well as to evaluate the safety and feasibility of this procedure.Methods From Jan 2013 to Oct 2015, we retrospectively analysis the perioperative data and primary follow-up data from 35 patients who underwent radical cystectomy with Da VinCi robotic laparoscopic in urological institution of Changhai Hospital.The median age was 65 （ranging from 46 to 78） years.The amount of male cases were 34, the female case were 1.There were three kinds of urinary diversion, ureterocutaneostomy, Bricker operation and orthotopic neobladder, were 2, 26 and 7 respectively.We collected the parameters including operating time, estimated blood loss, blood transfusion volume, time to flatus,length of hospital stay,perioperative complication,time of recurrence,time of death and the reason of death.Results All of the related operations had been accomplished successfully, none of which had been converted to the open procedure.The estimated operating time of ureterostomy was （315.0 ±106.1） min, Ideal conduit was （ 443.2 ±93.2 ） min, Orthotopic bladder was （ 488.3 ±80.6 ） min.The estimated intraoperative blood loss was 260.0 ±108.6（100 to 500 ）ml.5 cases of all patients were transfused 400ml red cell suspension, the transfusion rate was 14.2%.The mean time to flatus was 3.1 ±1.6（1 to 7） d.The estimated time to remove the gastric tube and the drainage tube was 4.2 ±2.2d（2-10d）,10.8 ±5.1d（4-25d）,respectively.The length of hospital stay after surgery was 12.4 ±5.17（6 to 25） d.Overall,17,8, 10,31 and 4 of these patients had 〈T2 ,T2 ,T3 ,N0 and N1-2 disease, respectively.Perioperative complication mainly included intestinal obstruction and lymphatic fistula,which occured 4 cases and 5 cases,respectively, recovering.All of them recovered completely with appropriate treatment.Distant metastasis was noticed in 4 cases.3 of them died due to the metastasis.The mean follow-

关 键 词：机器人 膀胱癌 根治性膀胱切除术 尿流改道术 

分 类 号：R737.14[医药卫生—肿瘤] TP242[医药卫生—临床医学]