机器人辅助回肠膀胱扩大术治疗神经源性膀胱的初步经验  

Primary experience in the treatment of neurogenic bladder with robotic assisted ileum augmentation cystoplasty

作　　者：朱李 祁小龙[1] 徐智慧[1] 毛祖杰[1] 刘锋[1] 沃奇军[1] 王帅[1] 张大宏[1] 王晏鹏[1] Zhu Li;Qi Xiaolong;Xu Zhihui;Mao Zujie;Liu Feng;Wo Qijun;Wang Shuai;Zhang Dahong;Wang Yanpeng(Department of Urology,Zhejiang Provincial People’s Hospital,Hangzhou 310000,China)

机构地区：[1]浙江省人民医院泌尿外科,杭州310000 [2]金华市中心医院泌尿外科工作,金华321000

出　　处：《中华泌尿外科杂志》2021年第2期104-109,共6页Chinese Journal of Urology

摘　　要：目的探讨机器人辅助回肠膀胱扩大术治疗神经源性膀胱的可行性、安全性和临床疗效。方法回顾性分析2017年3月至2018年11月浙江省人民医院收治的12例神经源性膀胱患者的病例资料,男11例,女1例。平均年龄38(12~67)岁。12例术前均有尿失禁、排尿障碍以及膀胱安全容量减小、膀胱内压力增高导致输尿管反流等症状,病因包括脊髓损伤8例,脊髓发育不良4例。12例术前均行间歇导尿。术前血肌酐(129.58±44.60)μmol/L,总肾小球滤过率(61.63±18.04)ml/(min·m2)。术前尿动力学检查:膀胱安全容量(95.67±39.10)ml,充盈期末膀胱内压力(63.30±6.02)cmH2O(1 cmH2O=0.098 kPa),膀胱顺应性(10.24±1.14)ml/cmH2O,残余尿量(152.58±80.89)ml,尿流率(3.88±3.63)ml/s。术前膀胱造影检查可见膀胱挛缩明显。超声检查示均有不同程度肾盂积水和输尿管扩张,输尿管反流分级Ⅰ度2例,Ⅱ度4例,Ⅲ度4例,Ⅳ度2例。12例均行机器人辅助回肠膀胱扩大术,采用5点穿刺法。横向切开膀胱前壁全层。在距回盲部20~25 cm处截取回肠约30 cm。纵行剖开回肠并将其中点缝合固定于膀胱后壁中点,以固定点为起点依次将肠管向膀胱两侧缝合,最后双侧输尿管分别置入1根单J管。记录术中出血情况、截取肠管时有无损伤邻近脏器、输尿管开口有无损伤、吻合口密闭性、吻合肠管是否通畅,以及术后并发症(吻合口瘘、肠梗阻、腹腔出血)、尿动力学检查参数和患者生活质量。患者术后6个月内应用托特罗定2 mg/d。结果本组12例手术均顺利完成,无中转开放手术。手术时间(120.80±12.00)min。术中出血量(84.00±23.20)ml。术后肠道功能恢复时间(3.30±1.30)d。术后住院时间(12.10±3.10)d。术后盆腔引流管留置时间(3.80±1.20)d。术后2周拔除导尿管和单J管。术后平均随访19.40(3~24)个月。术后3、12、24个月复查膀胱安全容量分别为(435.83±33.56)、(450.90±31.09)、(462.Objective To explore the feasibility,safety and clinical efficacy of ileum augmentation cystoplasty assisted by Da Vinci robot for the treatment of neurogenic bladder.Methods Retrospective analysis was performed on the data of 12 patients with neurogenic bladder admitted to Zhejiang Provincial People’s Hospital from March 2017 to November 2018,including 11 males and 1 female,with the mean age of 38(12-67).Preoperative symptoms were urinary incontinence,dysuria,decreased bladder capacity,or increased bladder pressure leading to ureteral reflux.All the 12 patients underwent preoperative intermittent catheterization,including 8 patients with spinal cord injury and 4 patients with spinal cord dysplasia.Preoperative serum creatinine(129.58±44.60)μmol/L and total glomerular filtration rate(61.63±18.04)ml/(min·m2)were observed in 12 patients.Preoperative urodynamic examination showed the safe bladder volume of(95.67±39.10)ml,bladder internal pressure of(63.30±6.02)cmH2O(1 cmH2O=0.098 kPa)at the end of filling period,bladder compliance of(10.24±1.14)ml/cmH2O,residual urine volume of(152.58±80.89)ml,and urine flow rate of(3.88±3.63)ml/s.Bladder contracture was evident on preoperative cystography.Ultrasound examination showed different degree of hydronephrosis and ureter expansion,in all cases,with ureteral reflux gradingⅠin 2 cases,gradeⅡin 4 cases,gradeⅢin 4 cases,gradeⅣin 2 cases.All the 12 patients underwent robot-assisted ileum augmentation cystoplasty with 5-point puncture.Transverse incision of the bladder wall before full thickness,according to the amount of bladder and quality to decide 30 cm(normal),longitudinal cut back loops and one point after suture fixation in the bladder wall midpoint,fixed point as starting point,in turn,will be blind to the bladder stitching on both sides,the bilateral ureteral placing a single J tube respectively,evaluation of surgical success rate(including intraoperative bleeding,interception of bowel loops are no damage adjacent viscera,ureter openings with and with

关 键 词：膀胱 神经原性 机器人手术 回肠 膀胱扩大术 尿动力学 

分 类 号：R694.5[医药卫生—泌尿科学]