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)

Robotic-assisted laparoscopy in urology with a report experience of 500 cases

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.

Objective:To summarize the experienceinthe earliest robotic-assistedlaparoscopic surgeryin urology and discuss its applied value .Methods:500 patients underwent robot-assisted laparoscopic urological surgery during 2007 October to 2013 Nove mber .Results:497 of 500 cases were operated successfully .The upper tract surgery was performedon135cases,accountingfor27.16 %,including2casesofadrenalectomy (0.4 %),60casesofpartialne-phrecto my (12.07 %),37 cases of radical nephrecto my (7.44 %),6 cases of nephroureterecto my (1.21 %),3 cases of unroofing of cyst of kidney (0.6 %),11 cases of pyeloplasty (2.21 %),14 cases of ureterovesical rei mplantation (2.82 %),1 case of ureterolysis (0.2 %),and 1 case of resecction of ureteral stenosis and ureteral anasto mosis (0.2 %).The lower urinary surgery was perfor med on 362 cases ,accounting for 72.84 %,including 319 cases of prostatecto my (64.19 %),24 cases of radical cystecto my and ileal conduit (4.83 %),7 cases of radical cystecto my and neobladder (1.41 %),3 cases of ureterocutaneosto my (0.6 %),3 cases of pelvic neoplas mresection (0.6 %),4 cases of excision of se minal vesicle neoplas m (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 fibro-sis 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 treatmentoutcomes,withthe manyadvantagessuchas withasmalltrauma,clearoperationfield,lessbloodloss and short learning curve .