基于女性盆底解剖的四步断离法机器人腹腔镜根治性膀胱切除术  

Four-step dissection method of robot-assisted laparoscopic radical cystectomy based on female pelvic cavity anatomy

作　　者：任选义 陶金[2] 范雅峰 李腾飞 于栓宝 张雪培[2] Ren Xuanyi;Tao Jin;Fan Yafeng;Li Tengfei;Yu Shuanbao;Zhang Xuepei(Department of Urology,Kaifeng Central Hospital,Kaifeng 475000,China;Department of Urology,the First Affiliated Hospital of Zhengzhou University,Zhengzhou 450052,China)

机构地区：[1]开封市中心医院泌尿外科,475000 [2]郑州大学第一附属医院泌尿外科,450052

出　　处：《中华实验外科杂志》2022年第10期2005-2007,共3页Chinese Journal of Experimental Surgery

摘　　要：目的基于女性盆底的解剖学特征,简化、组合机器人辅助腹腔镜根治性膀胱切除(RARC)的手术步骤并探讨其可行性。方法2016年1月至2021年12月,应用四步断离法RARC治疗女性膀胱癌(Bca)66例。关键步骤有,断输尿管、断血管蒂、断尿道、断阴道除标本。记录改良技术的应用情况、手术时间、术中出血量、标本取出方式和手术相关的并发症。结果66例RARC手术均成功,无膀胱或尿道破裂,未见直肠或盆腔大血管损伤。膀胱切除手术时间(60.6±14.7)min;术中估计出血量为(232.2±63.5)ml,3例膀胱侧血管蒂出血、2例子宫血管出血均有效控制。术后未见迟发性大出血,发生切口脂肪液化和阴道残端炎各2例,保守治愈。结论简化的四步断离法RARC手术步骤可重复,操作流程优化,安全可行。Objective Based on the anatomical characteristics of the female pelvic organs and structures,the surgical steps of robot-assisted laparoscopic radical cystectomy(RARC)were simplified and combined and its feasibility was explored.Methods From January 2016 to December 2021,66 cases of female bladder cancer(Bca)were treated by the four-step dissection method of RARC.Key steps:dissection of the ureter,dissection of the vascular pedicle,dissection of the urethra,dissection of the vagina soon remove the whole specimen.The applications of the modified technique,operation time,intraoperative blood loss,route of specimen removal,and related surgical complications were recorded.Results All 66 cases of RARC accomplished successfully,with no bladder or urethral rupture,and no rectum or pelvic major vessel injury occured.The operational time of cystectomy was(60.6±14.7)min.The estimated intraoperative blood loss was(232.2±63.5)ml,3 cases of bladder vascular pedicle and 2 cases of uterine vascular bleeding occurred and been controled effectively,no postoperative late-onset hemorrhage.2 cases of incisional fat liquefaction and 2 cases of vaginal stumpitis occurred and cured conservatively.Conclusion The simplified four-step dissection method of RARC is optimized and reproduciable,and the operational technique is safe and feasible.

关 键 词：机器人腹腔镜 女性 根治性膀胱切除 手术 

分 类 号：R699.5[医药卫生—泌尿科学]