机器人辅助腹腔镜顺行腹股沟淋巴结清扫术的临床研究  

A clinical study on robotic assisted laparoscopic antegrade inguinal lymphadenectomy

作　　者：郁华亮[1] 卢永良 肖毅[1] 邵志强[1] 郭加翔[1] 杨渝[1] 王宏伟[2] 高江平[1] 

机构地区：[1]解放军总医院第一附属医院泌尿外科,北京100048 [2]解放军总医院第一附属医院病理科,北京100048

出　　处：《中华泌尿外科杂志》2018年第1期38-41,共4页Chinese Journal of Urology

摘　　要：目的探讨机器人辅助腹腔镜顺行腹股沟淋巴结清扫术的手术方法及临床效果。 方法回顾性分析2016年8月至2017年8月收治的7例阴茎癌患者的临床资料。年龄（49.7±7.5）岁，范围40～62岁。体重指数（27.97±3.86）kg/m2，范围21.76～33.21 kg/m2。临床分期：T1期4例，T2期2例，T3期1例；7例术前查体及辅助检查均提示腹股沟淋巴结肿大，无盆腔淋巴结肿大，N1期1例，N2期3例，N3期3例；均无远处转移。术前常规评估心肺功能，行腹股沟及盆腔增强CT或MRI检查，行双下肢静脉B超检查。全麻，患者取平卧位，头低臀高约15°，双下肢伸直呈＂八＂字分开外展约45°，双膝关节稍屈曲外旋，将达芬奇机器人床旁机械臂由患者两腿间推入。术中于浅筋膜膜性层（Scarpa筋膜）与腹外斜肌腱膜表面之间钝性分离，用自制气囊扩张建立皮下空间后行腹股沟淋巴清扫术。 结果7例手术均顺利完成，无中转开放手术，术中均无需移动机械臂系统。4例术中利用原套管位置进入腹腔，同期行盆腔淋巴结清扫术。7例患者共13侧手术，每侧手术时间（70.0±12.51）min，范围50～90 min；术中出血量每侧均〈10 ml。左侧清扫淋巴结（14.0±3.3）枚，范围7～18枚；右侧清扫淋巴结（11.0±3.3）枚，范围5～21枚。7例均术后7 d拆线，未发生皮肤坏死、伤口延迟愈合、蜂窝织炎等并发症，3例术后出现淋巴漏。7例术后随访时间3～14个月，1例死于肿瘤进展、全身转移，余6例原发灶、腹股沟及盆腔淋巴结无复发、转移。 结论机器人辅助腹腔镜顺行腹股沟淋巴结清扫术能达到预期手术疗效，术中及术后并发症少。将机器人手术系统的机械臂置于患者双下肢之间，行双侧腹股沟淋巴结清扫时无需移动机械臂，可简化步骤，减少套管使用，如病情需要还可利用原套管位置同期行盆腔淋巴结清扫术。ObjectiveTo discuss the surgical strategy and clinical effects of robotic assisted laparoscopic antegrade inguinal lymphadenectomy for penile cancer. MethodsWe retrospectively analyzed the clinical data and surgical strategy on the 7 cases, who undergoing robotic assisted laparoscopic antegrade inguinal lymphadenectomy, from August of 2016 to August of 2017. The mean age of 7 patients was （49.7±7.5） years old, ranged from 40 to 62 years old, the mean BMI was （27.97±3.86） kg/m2, ranged from 21.76 to 33.21 kg/m2. There were 4 cases of T1, 2 cases of T2, 1 case of T3, 1 case of N1, 3 cases of N2, 3 cases of N3 according to TNM stages. Preoperative preparation was as follows, preoperative cardiopulmonary assessment, inguinal and pelvic CT or MRI, ultrasound of lower extremity venous, bowel preparation. The patients were placed in a supine position, with an indwelling catheter, with the head positioned lower than the hip at an angle of about 15 degrees, legs were spread apart around 45 degrees, and both knees were slightly bent and externally rotated. The da Vinci robotic patient cart was pushed forward between legs of the patient. A blunt separation was carried out between Scarpa＇s fascia and the surface of the aponeurosis of the obliquus externus abdominis prior, then subcutaneous space was established by a self-made balloon dilatation. Results7 cases were completed successfully without robot reposition without any conversion. Operative time of each side ranged from 50 to 90 min（70.0±12.5）min. The blood loss of each side was less than 10 ml. In the 7 cases, the number of nodes removed from left inguinal region ranged from 7 to 18 （14.0±3.3）. The number of nodes removed from right ranged from 5 to 21 （11.0±3.3）. Pelvic lymphadenectomy was completed in the meantime by original trocar site on 4 cases. Till now, no perioperative complications, such as flap necrosis, delayed healing of incision, cellulitis, occurred in inguinal region, except lymphorrhagia in 3 cases. During a follow-up w

关 键 词：机器人手术 阴茎癌 腹股沟淋巴结清扫术 

分 类 号：R737.27[医药卫生—肿瘤]