单中心40例机器人全腔内Studer原位新膀胱术的疗效分析  

Follow-up analysis of 40 cases of robotic intracorporeal studer orthotopic neobladder in a single center

作　　者：艾青[1] 程强[1] 赵旭鹏 沈诞[1] 刘侃[1] 王保军[1] 许勇[1] 马鑫[1] 张旭[1] 李宏召[1] Ai Qing;Cheng Qiang;Zhao Xupeng;Shen Dan;Liu Kan;Wang Baojun;Xu Yong;Ma Xin;Zhang Xu;Li Hongzhao(Department of Urology,The Third Medical Centre of Chinese PLA Genaral Hospital,Beijing 100853,China)

机构地区：[1]解放军总医院第三医学中心泌尿外科医学部,北京100853

出　　处：《中华泌尿外科杂志》2020年第11期835-839,共5页Chinese Journal of Urology

摘　　要：目的探讨机器人全腔内Studer原位新膀胱术(RISON)的疗效。方法回顾性分析2018年4月至2020年3月解放军总医院第三医学中心行RISON手术的40例患者的临床资料。男39例,女1例;年龄(56.4±9.9)岁,体质指数(25.5±3.1)kg/m2。其中4例术前行新辅助化疗。并发症综合指数评分0~2分6例,3~5分33例,6~8分1例。所有患者术前病理诊断为高级别尿路上皮癌或反复复发的膀胱肿瘤,肿瘤分期≤T2期,膀胱镜检查明确无膀胱颈及尿道浸润,肾功能良好。所有患者均行机器人辅助根治性膀胱切除及标准淋巴结清扫术,再采用RISON行尿流改道,选取距离回盲部30~40 cm的回肠最低点作为新膀胱颈口,选取构建新膀胱所需回肠约50 cm,并用切割闭合器恢复肠道连续性,保留近心输入段10 cm肠管的完整性,将其余肠管沿对系膜缘去管化,U型缝合新膀胱的后壁,将新膀胱前壁聚拢呈近似球形,并用倒刺线将浆肌层内翻缝合前壁。Wallace法行双侧输尿管吻合,并关闭新膀胱前壁的近心端。记录患者围手术期资料及术后随访情况,分析肿瘤控制结果、膀胱容量、控尿情况、性功能情况,以及近期(≤30 d)和远期(>30 d)并发症。结果40例手术均顺利完成,无中转开放或者更换手术方式,中位手术时间360(300.0,442.5)min,中位术中失血量200(200.0,337.5)ml,中位留置胃管时间3(3,4)d,中位进食时间3(3,5)d,中位术后住院时间9(8,10)d。术后病理分期:≤T2N0M0期39例,T3aN0M0期1例;1例手术切缘阳性,1例合并前列腺偶发腺癌;中位淋巴结清扫数量15(12,20)枚,未见淋巴结转移。12例发生近期并发症,其中ClavienⅠ级7例,ClavienⅡ级5例。18例发生远期并发症,其中ClavienⅠ级10例,ClavienⅡ级7例,ClavienⅢ级1例。随访时间1~24个月,术后随访满1年的34例患者中位膀胱容量300(0,400)ml,其中1例女性患者发生尿失禁。其余33例日间控尿(不使用尿垫)率93.9%(31/33),夜间需定时排尿(1~3�Objective To explore the curative effect of robotic intracorporeal studer orthotopic neobladder(RISON).Methods The clinical data of 40 patients who underwent RISON in our hospital from April 2018 to March 2020 were analyzed retrospectively,including 39 males and 1 female with an average age of(56.4±9.9)years,an average body mass index of(25.5±3.1)kg/m2.Four patients received preoperative neoadjuvant chemotherapy.Comorbidity component index score was 0-2 points in 6 cases,3-5 points in 33 cases,6-8 points in 1 case.All patients had definite pathological diagnosis for the high grade urothelial carcinoma or recurrent bladder tumors,and the tumor staging forecast within T2 stage.Biopsy of the posterior urethra and bladder neck revealed negative result of tumor invasion.The patients had normal kidney function and without any clear bowel disease history.All patients underwent robotic radical intracorporeal studer orthotopic neobladders and standard lymphadenectomy.About 30 to 40 cm from terminal ileum was selected as the new bladder neck and 50 cm ileum as neobladder.Restore intestinal continuity with EndoGIA.The intestinal canal was cut off along the offside of mesentery except for proximal 10 cm.After U-shape suture of the new bladder back wall,the new anterior bladder wall was sutured with barbs line further in pulp muscularis."Wallace"was performed bilateral ureteral anastomosis and closing the proximal end of the anterior wall of the new bladder.Further follow-up results were also collected to evaluate the clinical treatment effect,including pathological results of tumor,bladder capacity,urine control(usage of pads),sexual function,short-term(≤30 d)and long-term(>30 d)complications.Results All the RISONs were successfully performed without conversion to open operation.Median operation time was 360(300.0,442.5)min,blood loss was 200(200.0,337.5)ml,indwelling time of gastric tube was 3(3,4)d,full tolerance time was 3(3,5)d,and postoperative hospital stay was 9(8,10)d.Postoperative pathological results showed 39(

关 键 词：膀胱肿瘤 机器人 全腔内 Studer原位新膀胱术 尿流改道术 

分 类 号：R737.14[医药卫生—肿瘤]