机器人辅助单一体位经腹入路肾输尿管切除+膀胱袖状切除术治疗UTUC的疗效  

The clinical application of robot-assisted one-step transperitoneal nephroureterectomy for upper urinary tract urothelial carcinoma

作　　者：阮海龙 程功 陈志贤 叶聿中 杨雄 梁华庚 韩晓敏 蒋国松 章小平 Ruan Hailong;Cheng Gong;Chen Zhixian;Ye Yuzhong;Yang Xiong;Liang Huageng;Han Xiaomin;Jiang Guosong;Zhang Xiaoping(Department of Urology,Union Hospital,Tongji Medical College,Huazhong University of Science and Technology,Wuhan 430022,China)

机构地区：[1]华中科技大学同济医学院附属协和医院泌尿外科,武汉430022

出　　处：《中华泌尿外科杂志》2021年第11期810-813,共4页Chinese Journal of Urology

摘　　要：目的探讨机器人辅助单一体位经腹入路肾输尿管切除+膀胱袖状切除术治疗上尿路尿路上皮癌(UTUC)的疗效。方法回顾性分析2018年10月至2020年5月华中科技大学同济医学院附属协和医院收治的15例UTUC患者的临床资料。男8例,女7例;中位年龄58.6(52.6~69.6)岁;肿瘤位于肾盂8例,输尿管上段2例,输尿管中下段5例;左侧5例,右侧10例。15例均由同一术者行机器人辅助单一体位经腹入路肾输尿管切除+膀胱袖状切除术。患者取70°健侧卧位,整体10°头低足高位。常规游离肾脏周围并处理肾门后,向下游离输尿管至膀胱开口处,游离肾和输尿管时行淋巴结清扫,袖状切除膀胱和输尿管壁内段,缝合膀胱。记录手术时间、出血量及术后引流管和尿管放置时间等。结果15例手术均顺利完成,无中转开放手术。15例手术时间103(82~185)min,术中出血量60(30~120)ml。术后引流管放置时间3(2~5)d,术后住院时间5(4~7)d,术后尿管均放置14 d。15例术后病理诊断均为UTUC,无切缘阳性。术后中位随访时间15(10~30)个月,15例全部存活,其中1例术后6个月膀胱镜检查提示膀胱内复发,予膀胱肿瘤电切+膀胱灌注化疗药物后未见肿瘤进展,其余14例未见肿瘤复发或转移。结论机器人辅助单一体位经腹入路肾输尿管切除+膀胱袖状切除术治疗UTUC,无需改变患者体位和机器人泊位,手术时间较短,术后短期随访瘤控效果佳。Objective To explore the clinical application of robot-assisted laparoscopic single-position nephroureterectomy and bladder sleeve resection for upper urinary tract urothelial carcinoma(UTUC).Methods The clinicopathological data of 15 UTUC patients admitted to Union Hospital of Tongji Medical College of Huazhong University of Science and Technology from October 2018 to May 2020 were retrospectively analyzed.There were 8 males and 7 females,with a median age of 58.6(ranging 52.6-69.6)years,including 8 cases of renal pelvic cancer,2 cases of upper ureteral cancer,5 cases of middle and lower ureteral cancer.The tumor located on the left side in 5 cases and right side in 10 cases.All 15 patients underwent robot-assisted one-step transperitoneal nephroureterectomy and bladder sleeve resection by the same surgeon.The patients were placed in a 70°healthy side lying position with a 10°head lower and foot high position.After routinely dissecting the kidneys and controlling the renal hilum,we continued to dissect the ureter down to the orifice of the bladder.The lymph node dissection was performed when dissecting the kidney and ureter.Then the ureter was resected like a sleeve and the bladder was sutured.Observation indicators,such as operation time,blood loss,postoperative drainage tube and urinary catheter placement days,were recorded.Results All 15 patients were successfully completed the operation in the same position and the same robot berth without conversion.The median operation time was 103(ranging 82-185)min,and the intraoperative median blood loss was 60(ranging 30-120)ml.The postoperative median drainage catheter placement time was 3(ranging 2-5)d,the postoperative median hospital stay was 5(ranging 4-7)d,and the postoperative urinary catheters were placed for 14 days.Postoperative pathological examinations of 15 patients showed UTUC without positive margins.The median follow-up time was 15(ranging 10-30)months.All 15 patients survived.One patient was found a recurrence in the bladder after cystoscopy.There wa

关 键 词：癌 上尿路 机器人辅助腹腔镜 单一体位手术 肾输尿管切除术 

分 类 号：R699[医药卫生—泌尿科学]