机器人根治性膀胱切除术加双U原位膀胱术治疗肌层浸润性膀胱癌  

Clinical analysis of robotic assisted laparoscopic radical cystectomy and extracorporeal double-U shaped orthotopic neobladder with a modified urethral reconstruction for the treatment of muscle invasive bladder cancer

作　　者：何威[1] 徐兆平[1] 谢欣[1] 祝宇[1] 沈周俊[2] He Wei Xu Zhaoping Xie Xin Zhu Yu Shen Zhoujun(Department of Urology, Ruijin Hospital, Shanghai Jiaotong University, School of Medicine, Shanghai 200025, China Deparanent of Urology, Huashan Hospital, Fudan University, Shanghai 200040, China)

机构地区：[1]上海交通大学医学院附属瑞金医院泌尿外科,200025 [2]复旦大学附属华山医院泌尿外科,上海200040

出　　处：《中华腔镜泌尿外科杂志（电子版）》2016年第6期15-18,共4页Chinese Journal of Endourology(Electronic Edition)

基　　金：上海市卫计委面上项目(201540081)

摘　　要：目的探讨对于肌层浸润性膀胱癌患者，以机器人辅助腹腔镜行根治性膀胱切除术的可行性与安全性，同时介绍一种改良的双u原位新膀胱的尿道重建方法。方法2010年3月至2016年2月，上海交通大学医学院附属瑞金医院泌尿外科对8例经过挑选的肌层浸润性膀胱癌患者行达芬奇机器人辅助腹腔镜下根治性膀胱切除术。8例患者均为男性，年龄51~66岁，术前通过尿道膀胱肿瘤电切术（TURBT）证实肌层浸润性尿路上皮癌。病理诊断明确后，于经TURBT术后4周内手术。膀胱切除后，在机器人辅助腹腔镜下对尿道残端进行4针预缝，其后通过耻骨上5cm小切口取出标本，切取末段回肠以双U法成形为新膀胱，颈部与预缝的尿道吻合形成原位新膀胱。结果手术均顺利完成，手术时间300--420min，失血量800—1200ml，输血量600-1000ml。术后1例出现尿漏，在充分引流、加强营养后恢复。术后住院时间12-21d，术后均予GC方案（吉西他滨800mg／m2，顺铂70mg／m2）进行辅助化疗。随访4-60个月，1例于术后2年死于远处转移，另7例术后复查CTU无上尿路积水，日间控尿满意，夜间存在尿失禁。结论对于仔细选择过的患者，机器人辅助腹腔镜下根治性膀胱切除术是一种安全可行的术式。术中在机器人视野中预先缝合尿道，行体外尿流改道仅需较小切口，又缩短了手术时间，在技术上无法达到体内尿流改道的情况下，是一种值得推荐的选择。Objective To evaluate the feasibility and safety of robotic assisted laparoscopic radical cystectomy （RALRC） for the treatment of urothelial muscle invasive bladder cancer （MIBC）, and to introduce a new method of urethral reconstruction in the formation of double-U shaped neobladder. Methods RALRC was performed for eight selected male MIBC patients from March 2010 to February 2016, their age ranging from 51-66 years old, within four weeks after tmnsurethral resection of the bladder tumor （TURBT）, through which the pathological diagnosis was assured. After radical cystectomy was fulfilled, the urethral stump was presutured with four stitches and the specimen was retrieved through a vertical suprapubic incision 5 cm in length. Then the terminal ileum was harvested to form a neobladder in double-U shape and anastomosed to the presutured urethral stump. Results The operations were accomplished successfully. The operating time, estimated blood loss, transfusion was 300-420 minutes, 800-1200 ml, 600-1000 ml, respectively. One case of urinary leakage was encountered and relieved by itself after sufficient drainage and nutrition support. The postoperative hospital stay was 12-21 days, and an adjuvant chemotherapy by ＂gemcitabine-cisplatine, GC＂ regimen was recommended to all the patients andwas accepted by them. The follow up period was 4-60 months, one patient died of distant metastasis and the remaining seven cases survive till now, who are happy with their day continence. Nocturnal incontinence persists, but no evidence of hydronephrosis was identified by postoperative CTU. Conclusions RALRC is a safe and feasible modality for MIBC. Presuturing the urethral stump in robotic visual field, which helps reducing the operating time and incision length, could be a recommendable modality because intracorporeal urinary diversion （ICUD） remains techanically challenging.

关 键 词：肿瘤 机器人 膀胱切除术 尿流改道 

分 类 号：R737.14[医药卫生—肿瘤]