机器人辅助改良Y型原位新膀胱术的疗效和安全性  

Efficacy and safety of robot-assisted modified Y-shaped ileal orthotopic neobladder reconstruction

作　　者：赵烔蕾 毛卫浦 王奕铎 许斌 陈恕求[2] 朱伟东 陈明 吴剑平 ZHAO Tonglei;MAO Weipu;WANG Yiduo;XU Bin;CHEN Shuqiu;ZHU Weidong;CHEN Ming;WU Jianping(Southeast University School of Medicine,Nanjing 210003;Department of Urology,Affiliated Zhongda Hospital of Southeast University,Nanjing 210009;Surgical Research Center,Institute of Urology,Southeast University Medical School,Nanjing 210018;Department of Urology,Nanjing Lishui District People s Hospital,Zhongda Hospital Lishui Branch,Southeast University,Nanjing 211299,China)

机构地区：[1]东南大学医学院,江苏南京210003 [2]东南大学附属中大医院泌尿外科,江苏南京210009 [3]东南大学外科研究中心泌尿外科研究所,江苏南京210018 [4]东南大学附属中大医院溧水分院,南京市溧水区人民医院泌尿外科,江苏南京211299

出　　处：《现代泌尿外科杂志》2025年第2期137-142,共6页Journal of Modern Urology

摘　　要：目的探讨本中心改良术式机器人辅助改良Y型原位新膀胱术的疗效和安全性,为探索手术技巧和提高膀胱癌手术治疗水平提供参考。方法回顾性分析2020年2月—2022年8月在东南大学附属中大医院泌尿外科接受机器人辅助腹腔镜下根治性膀胱切除术、淋巴结清扫和改良Y型回肠原位新膀胱术的44例患者的临床资料,对手术体位、Trocar位置、关键手术步骤、患者围手术期情况、术后并发症、术后1年的新膀胱体积、最大尿流率、残余尿量、肾功能和随访期间的尿控功能进行报告与分析。结果44例患者手术均顺利完成,手术时间(314.32±51.02)min,改良Y型回肠原位新膀胱术时间(103.52±9.56)min,术中出血量(128.18±57.27)mL;术后恢复液体摄入时间(4.16±0.86)d,术后(14.02±3.20)d拔出输尿管支架和导尿管,拔出导尿管后1~2 d出院。15例患者发生Clavien-DindoⅡ级并发症,2例患者发生Ⅲ级并发症。患者平均随访时间(20.77±5.90)个月,随访期间发现1例患者排尿困难、2例泌尿道结石、2例不完全肠梗阻。术后新膀胱容量(195.75±15.51)mL,最大尿流率(20.30±2.05)mL/s,残余尿量(19.86±13.80)mL,血清肌酐(81.98±25.97)μmol/L。术后3个月患者日间和夜间尿失禁的发生率分别为20.45%和29.55%,术后6个月分别是11.36%和18.18%,术后12个月分别为4.55%和9.09%。结论机器人辅助改良Y型回肠原位新膀胱术具有良好的疗效及安全性,术后并发症发生率较低,可进一步在临床应用。Objective To investigate the efficacy and safety of robot-assisted modified Y-shaped ileal orthotopic neobladder reconstruction,so as to provide reference for clinical practice.Methods The clinical data of 44 patients who underwent robot-assisted laparoscopic radical cystectomy,lymph node dissection,and modified Y-shaped ileal orthotopic neobladder reconstruction during Feb.2020 and Aug.2022 were retrospectively analyzed.The surgical position,Trocar position,and key surgical steps were reported.The perioperative conditions,postoperative complications,neobladder volume,maximum urinary flow rate,postvoid residual,renal function,and urinary control function were recorded.Results All 44 surgeries were successfully completed,with operation time of(314.32±51.02)min,modified Y-shaped ileal orthotopic neobladder reconstruction time of(103.52±9.56)min,and bleeding volume of(128.18±57.27)mL.The postoperative time for fluid intake was(4.16±0.86)days,catheter indwelling time was(14.02±3.20)days,and patients were discharged 1 to 2 days after catheter removal.Clavien-Dindo gradeⅡandⅢcomplications occurred in 15 and 2 patients,respectively.During the follow-up of(20.77±5.90)months,dysuria occurred in 1 case,urethral calculi in 2 cases,and incomplete bowel obstruction in 2 cases.The postoperative neobladder capacity was(195.75±15.51)mL,maximal urinary flow rate(20.30±2.05)mL/s,postvoid residual(19.86±13.80)mL and serum creatinine(81.98±25.97)μmol/L.The incidence of daytime and nocturnal urinary incontinence 3,6 and 12 months after operation were 20.45%and 29.55%,11.36%and 18.18%,and 4.55%and 9.09%,respectively.Conclusion Robot-assisted modified Y-shaped ileal orthotopic neobladder reconstruction has favorable efficacy and safety,and low incidence of postoperative complications,which can be applied in clinical practice.

关 键 词：膀胱癌 机器人辅助腹腔镜 根治性膀胱切除术 改良Y型回肠原位新膀胱术 尿流改道 

分 类 号：R737.14[医药卫生—肿瘤]