机器人辅助与开放式根治性膀胱切除术后早期并发症的对比研究  

Comparison of early stage complications between robotic-assisted radical cystectomy and open radical cystectomy

作　　者：徐金山[1] 刘安伟[1] 任乾[1] 戴利和 汤仕杰 陈新[1] 贾高臻 马重[1] 张振声[1] 孙颖浩[1] 许传亮[1] Xu Jinshan Liu Anwei Ren Qian Dai Lihe Tang Shijie Chen Xin Jia Gaozhen Ma Chong Zhang Zhensheng Sun Yinghao Xu Chuanliang(Department of Urology, Changhai Hospital, Second Military Medical University, Shanghai 200433, Chin)

机构地区：[1]第二军医大学长海医院泌尿外科,上海200433

出　　处：《中华泌尿外科杂志》2017年第2期99-102,共4页Chinese Journal of Urology

摘　　要：目的 比较机器人辅助根治性膀胱切除术（robot-assisted radical cystectomy,RARC）与开放式根治性膀胱切除术（open radical cystectomy,ORC）术后早期并发症的发病特点.方法 回顾性分析2013年12月至2015年9月我们收治的148例行根治性膀胱切除术患者的临床资料.其中113例行ORC（ORC组）,男98例,女15例,平均年龄（67.2±9.9）岁;35例行RARC（RARC组）,男30例,女5例,平均年龄（64.5±8.5）岁.比较两组患者的手术时间、术中出血量、术中淋巴结清扫数量、术后输血例数、术后排气时间、恢复进食时间、引流管拔除时间、开始下床活动时间、术后90 d内早期并发症发生情况等.结果 ORC组和RARC组的手术时间分别为（315±102） min和（450 ± 87） min,术中出血量分别为（539 ± 400） ml和（332±193） ml,差异有统计学意义（P＜0.05）.ORC组和RARC组术后输血例数分别为26例和6例,术中淋巴结清扫数量分别为（13.1±5.1）枚和（13.0±4.1）枚,术后排气时间分别为（4.1±2.9）d和（4.1±1.6）d,恢复进食时间分别为（5.0±4.0）d和（4.4±2.1）d,引流管拔除时间分别为（8.9±5.5）d和（10.8±5.1）d,开始下床活动时间分别为（4.5±2.4）d和（3.9±1.1）d,术后住院时间分别为（13.2 ±11.5）d和（12.4 ±5.2）d,差异均无统计学意义（均P＞0.05）.ORC组和RARC组术后并发症发生率分别为38.1％ （43/113）和25.7％ （9/35）,差异无统计学意义（P＞0.05）,Clavien Ⅱ级及以上并发症例数分别为1例和20例,差异有统计学意义（P＜0.05）.ORC组术后并发症为肠梗阻（19例）、感染（14例）、淋巴漏（18例）,RARC组并发症为肠梗阻（4例）、淋巴漏（5例）,RARC组术后感染例数明显少于ORC组,差异有统计学意义（P＜0.05）.结论 与ORC比较,RARC能显著减少患者术中出血量,降低术后早期并发症的发生率.Objective To compare the incidence and characteristics of early stage complications between open radical cystectomy （ORC） and robot-assisted radical cystectomy （RARC）.Methods From December 2013 to September 2015,the demographic and perioperative data of l13 （98 males and 15 females） and 35 （30 males and 5 females） patients who had undergone ORC or RARC respectively were retrospectively analyzed.The average age of patients was （67.2 ± 9.9） and （64.5 ± 8.5） years old in ORC and RARC group,respectively.We reviewed operation time,estimated blood loss,number of dissected lymph node,transfusion rate,time to resumption of oral intake,postoperative drainage length,time to mobility after surgery and complication rate within 90 days after cystectomy.Results Mean operative time was significantly shorter in ORC group than in RARC group [（315 ± 102） min vs.（450 ± 87） min,P 〈 0.05].However,mean estimated blood loss was significantly more in ORC group than in RARC group [（539 ± 400） ml vs.（332 ± 193） ml,P =0.006],respectively.No significant differences were found in number of the dissected lymph nodes （13.1 ± 5.1 vs.13.0 ± 4.1）,blood transfusion rate （26 vs.6 patients）,time to resume the intestinal function [（4.1 ±2.9）d vs.（4.1 ± 1.6） d],time to resumption of oral intake [（5.0 ± 4.0） d vs.（4.4 ± 2.1） d],time to remove the drainage tube [（8.9 ± 5.5） d vs.（10.8 ±5.1） d],time to mobility after surgery [（4.5 ± 2.4） d vs.（3.9 ± 1.1） d] and postoperative length of hospital stay[（13.2 ± 11.5） d vs.（12.4 ± 5.2） d] between two groups respectively （P 〉 0.05）.The complication rate between the two groups was （38.1% vs.25.7%,P =0.226）.The complication above Clavien Ⅰ was significantly more in ORC group （20 vs.1,P =0.048）.The common complications following ORC were intestinal obstruction（n =19）,infection （n =14）,death （n =1）,leakage of urine （n =2） and lymphatic leakage （n =18）,while in RARC group th

关 键 词：膀胱癌 根治性膀胱切除术 并发症 机器人辅助 

分 类 号：R737.14[医药卫生—肿瘤]