机器人辅助腹腔镜完全腔内乙状结肠直肠膀胱术可行性研究  

Total intracorporeal robot-assisted laparoscopic MainzⅡrectosigmoid pouch

作　　者：符伟军[1] 宋勇[1] 王忠新[1] 孙圣坤[1] 张帆[1] 朱捷[1] 沈诞[1] 陈杰[1] 乔建国 张旭[1] Fu Weijun;Song Yong;Wang Zhongxin;Shun Shengkun;Zhang Fan;Zhu Jie;Sheng Dan;Chen Jie;Qiao Jianguo;Zhang Xu(Department of Urology,Chinese PLA General Hospital,Beijing 100853,China)

机构地区：[1]中国人民解放军总医院泌尿外科,北京100853

出　　处：《中华实验外科杂志》2019年第9期1675-1678,共4页Chinese Journal of Experimental Surgery

基　　金：教育部留学回国人员科研启动基金.

摘　　要：目的探讨机器人辅助腹腔镜完全腔内膀胱根治性切除及乙状结肠直肠膀胱术(MainzⅡ式)的手术步骤及随访效果.方法选择肌层浸润膀胱癌63岁女性患者,首先行机器人膀胱根性切除,手术步骤包括淋巴结清扫、根治性膀胱、子宫及输卵管切除.其次,在乙状结肠及直肠交界取20 cm肠管,对系膜缘切开肠管,后壁端端吻合,输尿管末端乳头状植入肠管,留置F8单J管,储尿囊留置F26导尿管,一起引出肛门,前壁两层缝合.结果腔内完成全部手术,手术时间470 min,出血量600 ml,术后肛管9d拔出,输尿管支架管分别于11d和12 d拔除.围手术期无并发症,术后定期随访2年,白天排尿4~5次,夜间排尿1~2次,血二氧化碳结合力(CO2CP)17.8 mmol/L.双肾无积水,无反流及尿失禁.结论机器人完全腔内膀胱根治切除及MainzⅡ式膀胱术步骤简单,是安全有效的治疗晚期膀胱癌方式之一.Objective To report the surgical techniques and results of robot-assisted laparoscopic radical cystectomy(RRC)with bilateral pelvic lymphadenectomy and the Sigma rectum pouch(Mainz Ⅱ)performed with an intracorporeal robotic technique at our center.Methods There was 1 female 63 years old with organ confined,muscle invasive transitional cell carcinoma of the bladder who underwent completely robot assisted surgery.The procedure included pelvic lymph node dissection,radical cystectomy with uterus and tubal structures,creation of the rectal sigmoid pouch and bilateral stented antireflux implantation of the ureters into the pouch.A 20 cm segment of the sigmoid was isolated.The posterior wall of the pouch were anastomosed side-to-side.And a nipple was formed by suturing the mucosa over the ureters to accomplish an antireflux mechanism.The F8 mono-pigtail ureteral stents were led out through the rectum,and a F26 Foley catheter was placed transanally for pouch drainage.Finally the anterior wall of the pouch was closed two layers.Results Operating time was 470 min and blood loss was 600 ml.The rectal tube was removal on the 9d postoperative day and the ureteral stents were removed 11 d and 12 d postoperatively.No intraoperative or postoperative complications were observed.The patients were followed up for 2 years,urinating 4-5 times per day and 1-2 times at night,CO2CP is 17.8mmol/L.The patient showed no upper urinary occlusion,reflux or urine incontinence.Conclusion To our knowledge,this is the first robotic radical cystectomy with intracorporeal continent urinary diversion(MainzⅡ),RRC with the Mainz PouchⅡmay become a simple and effective alternative surgical method for treating select patients with localized muscle invasive bladder cancer.

关 键 词：膀胱肿瘤 机器人辅助腹腔镜手术 膀胱根治性切除 可控性尿流改道 

分 类 号：R737.14[医药卫生—肿瘤]