“两段三叶法”在腹腔镜或机器人辅助腹腔镜下根治性膀胱切除术中的应用疗效  

The clinic efficacy of ＂two section and three leaves approach＂ on laparoscopic radical cystectomy or robot assisted radical cystectomy

作　　者：刘安伟[1] 徐伟东[1] 花梅免[1] 张振声[1] 杨波[1] 杨庆[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》2017年第5期332-336,共5页Chinese Journal of Urology

基　　金：上海市科委科技创新行动计划（16411969700）

摘　　要：目的探讨“两段三叶法”在腹腔镜下根治性膀胱切除术（1aparoscopic radical cystectomy，LRC）或机器人辅助腹腔镜下根治性膀胱切除术（robot assisted radical cystectomy，RARC）中的应用疗效。方法回顾性分析2013年1月至2015年12月我院因膀胱恶性肿瘤行LRC或RARC103例患者的临床资料。患者均为男性。年龄35—84岁，中位年龄64岁。根据膀胱切除方法分为两组：“两段三叶法”组46例，年龄（63．3±9．8）岁；4例（8．7％）既往有腹部手术史；体重指数（body mass index，BMI）（23．2±2．9）kg/m^2，其中≥24kg/m^2者24例；美国麻醉医师协会（American Society of Anesthesiologists，ASA）评分：1分5例、2分35例、3分6例；采用LRC30例，RARC16例。常规组57例，年龄（63．7±9．1）岁；9例（15．8％）既往有腹部手术史；BMI（23．0±2．2）kg／m^2，其中≥24kg／m^2者20例；ASA评分：1分12例、2分38例、3分7例；采用LRC42例，RARC15例。两组上述指标比较差异均无统计学意义（均P〉0．05）。“两段三叶法”组术中切除膀胱时先离断脐动脉，沿两侧髂内动脉游离膀胱侧蒂（一段）的外叶，分别以Hem-O-10k夹闭后离断膀胱各动脉、静脉等膀胱外侧蒂血管（一叶）达盆内筋膜；打开膀胱腹膜返折，沿输精管分离找到双侧精囊，充分游离膀胱和前列腺后方，对于难以直达前列腺尖部的患者，分别将膀胱侧蒂内叶（一叶）先行离断，充分抬起膀胱后再分离前列腺后方直达尖部。然后同常规法暴露膀胱前间隙，打开盆内筋膜，缝扎背深静脉复合体，离断前列腺侧蒂（一段、一叶）。比较两组手术时间、术中出血量、引流管放置时间等指标的差异。比较两组患者中BMII〉24kg／m^2者的手术时间、术中出血量差异。结果本研究103例手术均顺利完成，均无中转开放手术。“两段三叶法”组和常规组的手术时间分别�Objective To investigate the clinic efficacy of ＂two section and three leaves approach＂on laparoscopic radical cystectomy （LRC） or robot assisted radical cystectomy （RARC）. Methods A retrospective statistical analysis collected a total of 103 cases with bladder cancer undergoing LRC or RARC, from Jan 2013 to Dec 2015 in our center. Those patients were divided into two groups,including ＂two section and three leaves approach＂ group （46 cases） and conventional group （57 cases）. The two section , which means that to cut lateral prostate gland and lateral vesical gland respectively, the three leaves include lateral lobe of lateral vesical gland （ superior vesical arteries and veins）, medial lobe of lateral vesical gland and lateral prostate gland. In two groups,whose age ranged from 35 to 84 years, the median age were （63.3 ± 9. 8 ） years and （ 63.7 ± 9. 1 ） years, respectively. The median BMI values were （ 23.2 ± 2.9 ） kg/m2 and （23.0±2. 2） kg/m^2, respectively. The occurrence of history of abdominal surgery were 4 （8. 7% ） cases and 9 （15.8%） cases, respectively. In two section and three leaves approach, the ASA scores of 1,2,3 were found in 5,35,6 cases,respectively. In conventional group,the ASA scores of 1,2,3 were found in 12,38,7 cases, respectively. The difference between two groups in age distribution, BMI value, ASA score, history of abdominal surgery, urinary diversion, surgical methods, pathological staging and grading had no statistical significance （ P 〉 0. 05 ）. Then, the operation time, the blood loss and the time to remove drainage tube, et al of the above two groups were compared. Patients with BMI ≥ 24 kg/m^2 in the two groups were 24 cases and 20 cases,respectively, following the strategy based on BMI 324 kg/m^2 and BMI 〈 24 kg/m^2 to compare the difference of subgroups in the operation time and the bleeding amount, for the purpose of corroborating the applied effectiveness of ＂two section and three leaves approach＂ compared with

关 键 词：膀胱恶性肿瘤 腹腔镜下根治性膀胱切除术 机器人辅助腹腔镜下根治性膀胱 切除术 两段三叶法 

分 类 号：R737.14[医药卫生—肿瘤]