机器人辅助完全腹腔镜下根治性膀胱全切加尿流改道术后短期随访结果(附10例报告)

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摘要 目的:探讨机器人辅助完全腹腔镜下根治性膀胱全切除术加尿流改道术的临床可行性以及肿瘤学和功能预后。方法:2012年3月~2012年6月,对10例膀胱癌患者行机器人辅助完全腹腔镜下根治性膀胱全切除术加尿流改道术,其中8例行Studer新膀胱术,2例行回肠膀胱术,所有操作均在机器人辅助腹腔镜下完成。结果:10例手术均获成功,平均手术时间为471(365~667)min,平均出血量409(170~1 200)ml。平均淋巴结清扫数目为18(9~25)枚,手术切缘均阴性。2例回肠膀胱术后1月拔除输尿管支架管;8例原位新膀胱术后1月行膀胱造影,所有病例确定没有吻合口漏后拔除尿管和双侧输尿管支架管。术后平均住院时间为12(8~26)d,术后随访19(18~20)个月,2例出现转移,死亡1例。其余病例肾功能正常,尿控较满意。结论:根据初期的手术操作过程和随访结果,机器人辅助完全腹腔镜下根治性膀胱全切除加尿流改道术在临床上是可行的。更多的操作经验,长期和前瞻性的对照研究将有助于对这一技术的评估。

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	瓦斯里江·瓦哈甫
	马鑫
	张旭
	李宏召
	丁强
	陈光富
	孙圣坤
	王保军
	史涛坪

关键词 ：机器人, 膀胱切除术, 尿流改道, 功能, 肿瘤学预后

Abstract：Objective: To investigate the clinical feasibility of Robot-assisted radical cystectomy (RARC) with totally intracorporeal urinary diversion (ICUD) and to present oncologic and functional outcomes.Methods: From March 2012 to June 2012, RARC with ICUD was performed on 10 patients diagnosed preoperatively with the bladder urothelial carcinomas. All patients underwent ICUD following RARC (ileal conduit urinary diversion for 2 patients and orthotopic ileal neobladder for 8 patients).Results: All patients underwent the laparoscopic procedure as planned. The operative time was 365-667 min (mean 471 min) with blood loss of 170-1 200 mL (mean 409 mL), and the number of removed lymph nodes was 9-25 (mean 18). For 2 patients undergoing ileal conduit urinary diversion, the ileoureteral stents were removed at 1st month. And for 8 patients undergoing orthotopic ileal neobladder, the ileoureteral stents and the urethral catheter were removed one month after a cystogram with confirmed watertight healing. Hospital stay was 8-26 days (mean 12 days). During the follow up period of 18-20 months (mean 19 months), 2 patients had disease recurrence and 1 died of disease. The remaining patients had satisfactory urinary continence and normal renal functions.Conclusions: With initial surgery and short-term follow-up, RARC with totally intracorporeal urinary diversion is feasible. More extensive surgical experiences as well as longer-term and more randomized trials will be required to better assess the appropriateness and potential of this technique.

Key words： robotics cystectomy urinary diversion function oncologic outcome

收稿日期: 2014-01-12

ZTFLH:

R737.14

通讯作者: 张旭,xzhang@foxmail.com

引用本文:

瓦斯里江·瓦哈甫,马鑫,张旭,李宏召,丁强,陈光富,孙圣坤,王保军,史涛坪. 机器人辅助完全腹腔镜下根治性膀胱全切加尿流改道术后短期随访结果(附10例报告)[J]. 微创泌尿外科杂志, 2014, 3(1): 12-16.
Wasilijiang Wahafu,Ma Xin,Zhang Xu,Li Hongzhao,Ding Qiang,Chen Guangfu,Sun Shengkun,Wang Baojun,Shi Taoping. Robot-assisted laparoscopic radical cystectomy with totally intracorporeal urinary diversion: short-term outcomes (Report of 10 cases). JOURNAL OF MINIMALLY INVASIVE UROLOGY, 2014, 3(1): 12-16.

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http://journal20.magtechjournal.com/Jwk_zgmnwk/CN/abstract/abstract933.shtml 或 http://journal20.magtechjournal.com/Jwk_zgmnwk/CN/Y2014/V3/I1/12

[1] Challacombe BJ, Bochner BH, Dasgupta P, et al. The role of laparoscopic and robotic cystectomy in the management of muscle-invasive bladder cancer with special emphasis on cancer control and complications. Eur Urol, 2011, 60(4): 767-775.
[2] Parekh DJ, Messer J, Fitzgerald J, et al. Perioperative outcomes and oncologic efficacy from a pilot prospective randomized clinical trial of open versus robotic assisted radical cystectomy. J Urol, 2013, 189(2): 474-479.
[3] Ahmed K, Ibrahim A, Wang TT, et al. Assessing the cost effectiveness of robotics in urological surgery-a systematic review. BJU Int, 2012, 110(10): 1544-1556.
[4] Guru KA, Kim HL, Piacente PM, et al. Robot-assisted radical cystectomy and pelvic lymph node dissection: initial experience at Roswell Park Cancer Institute. Urology, 2007, 69(3): 469-474.
[5] Pruthi RS, Wallen EM. Robotic assisted laparoscopic radical cystoprostatectomy: operative and pathological outcomes. J Urol, 2007, 178(3 Pt 1): 814-818.
[6] Murphy DG, Challacombe BJ, Elhage O, et al. Robotic-assisted laparoscopic radical cystectomy with extracorporeal urinary diversion: initial experience. Eur Urol, 2008, 54(3): 570-580.
[7] Nix J, Smith A, Kurpad R, et al. Prospective randomized controlled trial of robotic versus open radical cystectomy for bladder cancer: perioperative and pathologic results. Eur Urol, 2010, 57(2): 196-201.
[8] Pruthi RS, Nielsen ME, Nix J, et al. Robotic radical cystectomy for bladder cancer: surgical and pathological outcomes in 100 consecutive cases. J Urol, 2010, 183(2): 510-514.
[9] Smith AB, Raynor M, Amling CL, et al. Multi-institutional analysis of robotic radical cystectomy for bladder cancer: perioperative outcomes and complications in 227 patients. J Laparoendosc Adv Surg Tech A, 2012, 22(1): 17-21.
[10] Menon M, Hemal AK, Tewari A, et al. Robot-assisted radical cystectomy and urinary diversion in female patients: technique with preservation of the uterus and vagina. J Am Coll Surg, 2004, 198(3): 386-393.
[11] Beecken WD, Wolfram M, Engl T, et al. Robotic-assisted laparoscopic radical cystectomy and intra-abdominal formation of an orthotopic ileal neobladder. Eur Urol, 2003, 44(3): 337-339.
[12] Pruthi RS, Nix J, McRackan D, et al. Robotic-assisted laparoscopic intracorporeal urinary diversion. Eur Urol, 2010, 57(6): 1013-1021.
[13] Jonsson MN, Adding LC, Hosseini A, et al. Robot-assisted radical cystectomy with intracorporeal urinary diversion in patients with transitional cell carcinoma of the bladder. Eur Urol, 2011,60(5): 1066-1073.
[14] 符伟军, 张旭. 腹腔镜或机器人辅助腹腔镜根治膀胱全切术后完全体内尿流改道. 微创泌尿外科杂志,2012,1(1): 41-45.
[15] Hautmann RE, Abol-Enein H, Davidsson T, et al. ICUD-EAU International Consultation on Bladder Cancer 2012: Urinary diversion. Eur Urol, 2013, 63(1): 67-80.
[16] Wang GJ, Barocas DA, Raman JD, et al. Robotic vs open radical cystectomy: prospective comparison of perioperative outcomes and pathological measures of early oncological efficacy. BJU Int, 2008, 101(1): 89-93.
[17] Kauffman EC, Ng CK, Lee MM, et al. Critical analysis of complications after robotic-assisted radical cystectomy with identification of preoperative and operative risk factors. BJU Int, 2010, 105(4): 520-527.
[18] 朱捷, 高江平, 徐阿祥,等. 机器人辅助腹腔镜根治性膀胱切除体外尿流改道术. 中华外科杂志,2009,47(16): 1242-1244.
[19] 陈光富, 张旭, 史立新,等. 机器人辅助腹腔镜下根治性膀胱切除加尿流改道术的临床分析. 中华泌尿外科杂志, 2012,33(10): 744-748.
[20] Saika T, Arata R, Tsushima T, et al. Health-related quality of life after radical cystectomy for bladder cancer in elderly patients with an ileal conduit, ureterocutaneostomy, or orthotopic urinary reservoir: a comparative questionnaire survey. Acta Med Okayama, 2007, 61(4): 199-203.
[21] Canda AE, Atmaca AF, Altinova S, et al. Robot-assisted nerve-sparing radical cystectomy with bilateral extended pelvic lymph node dissection (PLND) and intracorporeal urinary diversion for bladder cancer: initial experience in 27 cases. BJU Int, 2012, 110(3): 434-444.
[22] Tyritzis SI, Hosseini A, Collins J, et al. Oncologic, functional, and complications outcomes of robot-assisted radical cystectomy with totally intracorporeal neobladder diversion. Eur Urol, 2013, 64(5): 734-741.
[23] Ahmed K, Khan SA, Hayn MH, et al. Analysis of intracorporeal compared with extracorporeal urinary diversion after robot-assisted radical cystectomy: Results from the International Robotic Cystectomy Consortium. Eur Urol, 2014, 65(2): 340-347.
[24] Stenzl A, Cowan NC, De Santis M, et al. Treatment of muscle-invasive and metastatic bladder cancer: update of the EAU guidelines. Eur Urol, 2011, 59(6): 1009-1018.
[25] Zehnder P, Studer UE, Skinner EC, et al. Super extended versus extended pelvic lymph node dissection in patients undergoing radical cystectomy for bladder cancer: a comparative study. J Urol, 2011, 186(4): 1261-1268.
[26] Skarecky DW, Brenner M, Rajan S, et al. Zero positive surgical margins after radical prostatectomy: is the end in sight. Expert Rev Med Devices, 2008, 5(6): 709-717.
[27] Skinner EC, Stein JP, Skinner DG. Surgical benchmarks for the treatment of invasive bladder cancer. Urol Oncol, 2007, 25(1): 66-71.