机器人辅助腹腔镜根治性膀胱切除术中体内及体外尿流改道临床疗效对比分析  

Efficacy of intracorporeal versus extracorporeal urinary diversion with robot-assisted laparoscopic radical cystectomy:an analysis of 54 cases

作　　者：范世达 任尚青 吕倩[1] 周放 陈正军 冯华林 王强[1] 罗铖 欧勇 卫义 王尧谦 聂钰 黄娇娇 田景芝 王东[1] FAN Shida;REN Shangqing;LYU Qian;ZHOU Fang;CHEN Zhengjun;FENG Hualin;WANG Qiang;LUO Cheng;OU Yong;WEI Yi;WANG Yaoqian;NIE Yu;HUANG Jiaojiao;TIAN Jingzhi;WANG Dong(Department of Robotic Minimally Invasive Surgery,Sichuan Academy of Medical Sciences&Sichuan Provincial People's Hospital,Chengdu,Sichuan Province,610072,China)

机构地区：[1]四川省医学科学院·四川省人民医院机器人微创中心,成都610072

出　　处：《第三军医大学学报》2021年第23期2519-2524,共6页Journal of Third Military Medical University

摘　　要：目的对比分析机器人辅助腹腔镜根治性膀胱切除术(robot-assisted laparoscopic radical cystectomy,RARC)中采用体内尿流改道术(intracorporeal urinary diversion,ICUD)与体外尿流改道术(extracorporeal urinary diversion,ECUD)的临床疗效。方法回顾性分析四川省人民医院2019年1月至2020年6月因诊断为肌层浸润性膀胱癌(muscle invasive bladder cancer,MIBC)并接受RARC患者的资料。根据术中采取不同尿流改道方式分为两组,A组采用完全体内尿流改道方式,共18例;B组采用体外尿流改道方式,共36例。对比分析两组的手术时间、出血量、淋巴结清扫数量、术后肠道功能恢复时间、术后住院时间、术后拔除血浆引流管时间、术后并发症发生率、术后尿控率等。结果54例患者手术均成功,无1例中转开放。A组手术时间为270(240~320)min,明显短于B组[330(295~380)min,P<0.05];两组术中出血量、淋巴结清扫数量差异均无统计学意义(P>0.05);两组术后肠道功能恢复时间、住院时间、拔除血浆引流管时间及术后尿控率差异均无统计学意义(P>0.05)。术后行尿道膀胱造影提示两组新膀胱位置正常,容量接近正常膀胱容量,且未见明显输尿管反流。术后并发症:B组有2例术后出现急性肠梗阻并发肠道缺血坏死,1例出现不全性肠梗阻,1例出现肺部感染;A组有1例出现不全性肠梗阻,2例出现泌尿系感染;经相应治疗后均治愈。结论行RARC的患者采用完全体内尿流改道和体外尿流改道都能获得较好的临床疗效,完全体内尿流改道手术时间更短,更能体现机器人辅助技术的优势。Objective To compare the clinical efficacy of intracorporeal urinary diversion(ICUD)and extracorporeal urinary diversion(ECUD)with robot-assisted laparoscopic radical cystectomy(RARC).Methods A retrospective analysis was carried out on the patients who were diagnosed with muscle invasive bladder cancer(MIBC)and received RARC in our hospital from January 2019 to June 2020.According to the different urinary diversion adopted during the operation,they were divided into complete internal urinary diversion(ICUD group,n=18)and external urinary diversion(ECUD group,n=36).The operation time,blood loss amount,number of dissected lymph nodes,time of postoperative intestinal function recovery,length of postoperative hospital stay,time of removing plasma drainage tube,incidence of postoperative complications and rate of postoperative urinary control were compared between the 2 groups.Results RARC surgery successfully performed in all the 54 cases,and none of them were transferred to open surgery.The operation time of ICUD group was 270(240~320)min,which was significantly shorter than that of ECUD group[330(295~380)min,P<0.05].There were no obvious differences in the intraoperative volume of blood loss and number of dissected lymph nodes,or in the time of intestinal function recovery,length of hospital stay,time of removing plasma drainage tube,or rate of postoperative urinary control between the 2 groups(P>0.05).Postoperative urethral cystography showed that the new bladders located in normal position,with closely to normal capacity and no obvious ureteral reflux in the 2 groups.There were 2 cases of acute intestinal obstruction and intestinal ischemic necrosis after operation,1 case of incomplete intestinal obstruction and 1 cases of pulmonary infection in ECUD group,and 1 case of incomplete intestinal obstruction and 2 cases of urinary tract infection in ICUD group.All of these were relieved after corresponding treatment.Conclusion Whether complete ICUD or ECUD can obtain good clinical outcome for RARC,and the former has s

关 键 词：膀胱癌 机器人手术系统 体内尿流改道术 体外尿流改道术 

分 类 号：R181.32[医药卫生—流行病学] K699.5[医药卫生—公共卫生与预防医学]