机器人辅助腹腔镜在泌尿外科手术中的临床应用(附500例报告)

摘要
图/表
参考文献
相关文章 (15)

全文: PDF (733 KB)
输出: BibTeX | EndNote (RIS)

摘要 目的:总结早期开展机器人辅助腹腔镜手术在泌尿外科应用的经验,探讨机器人辅助腹腔镜在泌尿外科中应用价值。方法:分析2007年10月~2013年11月行机器人辅助腹腔镜泌尿外科手术500例患者。结果:500例中497例成功完成手术,上尿路手术135例,占27.16%,包括肾上腺癌切除术2例(0.4%)、肾部分切除术60例(12.07%)、肾根治性切除术37例(7.44%)、肾输尿管全长切除术6例(1.21%)、肾囊肿去顶减压术3例(0.6%)、肾盂成形术11例(2.21%)、输尿管膀胱再植术14例(2.82%)、输尿管探查松解术1例(0.2%)、输尿管狭窄段切除及端端吻合1例(0.2%)。下尿路手术362例,占72.84%,包括前列腺癌根治术319例(64.19%)、膀胱根治性切除术及回肠膀胱术24例(4.83%)、原位新膀胱术7例(1.41%)、输尿管皮肤造瘘3例(0.6%)、盆腔肿物切除术3例(0.6%)、精囊肿物切除术4例(0.8%)、膀胱结石碎石术1例(0.2%)、骶骨加固术1例(0.2%)。中转开放手术3例,包括腹膜后纤维化松解术1例、前列腺癌根治术1例、膀胱全切1例,占0.6%。无显著并发症发生。结论:遵循开放手术及普通腹腔镜原则,机器人辅助腹腔镜手术在技术上是安全有效的,可取得满意的临床治疗效果。具有创伤小、术野清晰、失血少及学习曲线短等优点。

	服务

	把本文推荐给朋友
	加入我的书架
	加入引用管理器
	E-mail Alert
	RSS
	作者相关文章

关键词 ：机器人辅助, 腹腔镜, 泌尿外科

Abstract：Objective:To summarize the experience in the earliest robotic-assisted laparoscopic surgery in urology and discuss its applied value. Methods:500 patients underwent robot-assisted laparoscopic urological surgery during 2007 October to 2013 November. Results:497 of 500 cases were operated successfully. The upper tract surgery was performed on 135 cases, accounting for 27.16%, including 2 cases of adrenalectomy (0.4%), 60 cases of partial nephrectomy (12.07%), 37 cases of radical nephrectomy (7.44%), 6 cases of nephroureterectomy (1.21%), 3 cases of unroofing of cyst of kidney (0.6%), 11 cases of pyeloplasty (2.21%), 14 cases of ureterovesical reimplantation (2.82%), 1 case of ureterolysis (0.2%), and 1 case of resecction of ureteral stenosis and ureteral anastomosis (0.2%). The lower urinary surgery was performed on 362 cases, accounting for 72.84%, including 319 cases of prostatectomy (64.19%), 24 cases of radical cystectomy and ileal conduit (4.83%), 7 cases of radical cystectomy and neobladder (1.41%), 3 cases of ureterocutaneostomy (0.6%), 3 cases of pelvic neoplasm resection (0.6%), 4 cases of excision of seminal vesicle neoplasm (0.8%), 1 case of lithotripsy of bladder calculus (0.2%), and 1 case of sacrocolpopexy (0.2%). Three cases were converted to open surgery (0.6%), including the retroperitoneal fibrosis release in 1 case, radical prostatectomy in 1 case, and cystectomy in 1 case. All the patients recovered without any complication. Conclusions:Following the principles and dissecting anatomical surface of open and laparoscopic surgery, the robotic-assisted laparoscopic surgery is safe and effective technically, and can gain satisfied clinical treatment outcomes, with the many advantages such as with a small trauma, clear operation field, less blood loss and short learning curve.

Key words： robotic-assisted laparoscopy urology

收稿日期: 2013-12-05

ZTFLH:

R69

基金资助:国家高技术研究发展计划(2012AA021101)

通讯作者: 张旭,xzhang@foxmail.com

引用本文:

张旭,高江平,符伟军,董隽,陈光富,徐阿祥,马鑫,李宏召,史立新,王威,朱捷. 机器人辅助腹腔镜在泌尿外科手术中的临床应用(附500例报告)[J]. 微创泌尿外科杂志, 2014, 3(1): 4-7.
Zhang Xu,Gao Jiangping,Fu Weijun,Dong Jun,Chen Guangfu,Xu Axiang,Ma Xin,Li Hongzhao,Shi Lixin,Wang Wei Zhu Jie. Robotic-assisted laparoscopy in urology with a report experience of 500 cases. JOURNAL OF MINIMALLY INVASIVE UROLOGY, 2014, 3(1): 4-7.

链接本文:

http://journal20.magtechjournal.com/Jwk_zgmnwk/CN/abstract/abstract931.shtml 或 http://journal20.magtechjournal.com/Jwk_zgmnwk/CN/Y2014/V3/I1/4

[1]张旭, 丁强. 机器人技术的沿革与展望. 微创泌尿外科杂志, 2013, 2(4): 225-226.
[2]Babbar P, Hemal AK. Robot-assisted urologic surgery in 2010-Advancements and future outlook. Urol Ann, 2011, 3(1): 1-7.
[3]Ficarra V, Cavalleri S, Novara G, et al. Evidence from robot-assisted laparoscopic radical prostatectomy: a systematic review. Eur Urol, 2007, 51(1): 45-55.
[4]Lavery HJ, Small AC, Samadi DB, et al. Transition from laparoscopic to robotic partial nephrectomy: the learning curve for an experienced laparoscopic surgeon. JSLS,2011,15(3): 291-297.
[5]Benway BM, Wang AJ, Cabello JM, et al. Robotic partial nephrectomy with sliding-clip renorrhaphy: technique and outcomes. Eur Urol, 2009,55(3): 592-599.
[6]Coelho RF, Palmer KJ, Rocco B, et al. Early complication rates in a single-surgeon series of 2500 robotic-assisted radical prostatectomies: report applying a standardized grading system. Eur Urol, 2010,57(6): 945-952.
[7]Gupta NP, Nayyar R, Hemal AK, et al. Outcome analysis of robotic pyeloplasty: a large single-centre experience. BJU Int, 2010,105(7): 980-983.
[8]Braga LH, Pace K, DeMaria J, et al. Systematic review and meta-analysis of robotic-assisted versus conventional laparoscopic pyeloplasty for patients with ureteropelvic junction obstruction: effect on operative time, length of hospital stay, postoperative complications, and success rate. Eur Urol,2009, 56(5): 848-857.
[9]Wang AJ, Bhayani SB. Robotic partial nephrectomy versus laparoscopic partial nephrectomy for renal cell carcinoma: single-surgeon analysis of ＞100 consecutive procedures. Urology, 2009,73(2): 306-310.
[10]Liberman D, Trinh QD, Jeldres C, et al. Is robotic surgery cost-effective: yes. Curr Opin Urol, 2012, 22(1): 61-65.
[11]Lotan Y. Is robotic surgery cost-effective: no. Curr Opin Urol, 2012,22(1): 66-69.
[12]Boger M, Lucas SM, Popp SC, et al. Comparison of robotassisted nephrectomy with laparoscopic and hand-assisted laparoscopic nephrectomy. JSLS, 2010,14(3): 374-380.