机器人"单孔+2"腹膜外全膀胱切除术+完全腔内尿流改道的初步应用  

Initial experience of the robotic laparoendoscopic"single site+2"radical cystectomy via extraperitoneal approach with a totally intracorporeal urinary diversion

作　　者：杨潇[1] 庄俊涛 蔡令凯 刘沛昆 吴启开 李鹏超[1] 曹强[1] 吕强[1] Yang Xiao;Zhuang Juntao;Cai Lingkai;Liu Peikun;Wu Qikai;Li Pengchao;Cao Qiang;Lyu Qiang(Department of Urology,the First Affiliated Hospital of Nanjing Medical University(Jiangsu Province Hospital),Nanjing 210029,China)

机构地区：[1]南京医科大学第一附属医院(江苏省人民医院)泌尿外科,南京210029

出　　处：《中华实验外科杂志》2023年第12期2468-2471,共4页Chinese Journal of Experimental Surgery

基　　金：国家自然科学基金(82072832、82273152);江苏省人民医院(南京医科大学第一附属医院)临床能力提升工程项目(JSPH-MA-2022-5、JSPH-MC-2021-15)。

摘　　要：目的探讨机器人辅助"单孔+2"腹膜外全膀胱切除术+完全腔内尿流改道的手术疗效。方法选取2022年8月至12月于南京医科大学第一附属医院就诊的5例膀胱癌患者,年龄55~82岁,其中男4例,女1例,经术者评估后行腹膜外全膀胱切除术。手术采用达芬奇XI机器人手术系统,脐下约7 cm切口置入LAGIS多通道单孔腹腔镜手术穿刺器,切口两侧约7 cm处分别做小切口,左侧置入12 mm腹腔镜鞘卡,右侧置入8 mm机器人鞘卡,构建"单孔+2"腹膜外入路全膀胱切除术鞘卡分布体系。观察手术时间、术中出血量、术后通气时间等。定期随访,密切关注患者并发症发生率及肿瘤学预后。结果5例患者年龄55~82岁,其中男4例,女1例。2例患者行腹壁造口,3例患者行完全腔内Wallace法回肠流出道。5例患者均顺利完成手术,无1例中转开放或转为腹腔入路。所有患者手术时间220~405 min,平均手术时间290 min;术中出血量100~150 ml,平均术中出血量126 ml。所有患者均在48 h内恢复通气,平均通气时间33.4 h。目前随访6.0~8.6个月,尚未出现肠梗阻或肿瘤复发转移。结论机器人辅助"单孔+2"腹膜外全膀胱切除术安全可行,完全体内尿流改道进一步减少手术创伤,加速康复。Objective To investigate the effect of robotic laparoendoscopic"single site+2"radical cystectomy(RC)utilizing an extraperitoneal approach,complemented by a totally intracorporeal urinary diversion.Methods During August to December 2022,five patients with bladder cancer were underwent RC through extraperitoneal approach by Da Vinci XI robotic surgical system.The five patients were 55-82 years,including 4 males and 1 female.LAGIS single-port was placed about 7 cm below the umbilicus.At about 7 cm on both sides of the port,a 12 mm Trocar was placed on the left side,and an 8 mm Trocar was placed on the right side.The system called"single site+2"was constructed.Operation time,blood loss and intestinal recovery time were observed.Follow-up was conducted regularly to collect the incidence of complications and the prognosis.Results Two patients underwent ureterocutaneostomy and three underwent intracorporeal ileal conduit.All the 5 patients successfully completed the operation.No one transferred to open or peritoneal approach.The operative time was 220-405 min(average time 290 min).Intraoperative blood loss was 100-150 ml(average blood loss 126 ml).All patients resumed intestinal recovery within 48 hours(average intestinal recovery time 33.4 hours).At present,all patients were followed up for 6.0-8.6 months,and there was no intestinal obstruction or tumor recurrence.Conclusion Robotic laparoendoscopic"ingle site+2"extraperitoneal approach for RC is safe and feasible,intracorporeal urinary diversion can further reduce surgical trauma and accelerate recovery.

关 键 词：单孔 机器人 腹膜外入路 全膀胱切除术 

分 类 号：R737.14[医药卫生—肿瘤]