机器人辅助腹腔镜下根治性膀胱切除-尿流改道术有效性评价

Effect of robotic-assisted laparoscopic radical cystectomy and urinary diversion

目的探讨机器人辅助腹腔镜下膀胱全切-尿流改道术（RARC）在治疗膀胱癌安全性与有效性。方法收集北京二炮总医院于2010年3月运用DaVinci机器人辅助腹腔镜行根治性膀胱切除-回肠膀胱术治疗1例膀胱癌资料。通过仔细阅读近期国内外相关文献，并进行分析。结果（1）该病例手术时间为540min，术中失血量为200ml，输血0ml，术后第3天排气，术后第4天下床活动，术后病理检查提示：低级别浸润型尿路上皮癌，术后第28天出院。（2）国内外RARC已超过400例。RARC组并发症发生率（31％与28％）、淋巴结清扫数（18．2个与13．0个）略高于常规腹腔镜下膀胱切除-尿流改道术（LCR）组；RARC组手术时间（285．7min与372．0min）、术中失血量（286．4ml与556．0m1）、平均住院日（8．6d与13d）低于LCR组。结论RARC为有效的治疗膀胱癌的新术式，因国内外样本量较少，手术经验不足。需以后进行大样本、长期随访的高质量临床研究，并及时更新系统评价其有效性和安全性．

Objective To assess the safety and effectiveness of robotic-assisted laparoscopic radical cystectomy and urinary diversion in the treatment of bladder cancer. Methods We collected the clinical data of one patient with bladder cancer who underwent RCRA with ileal neobladder from the Second Artillery General Hospital in Beijing on March,2010. Literature on this topic was analyzed. Results （ 1 ） The operation duration of this procedure was 540 mins. The intra-operative blood loss was 200 ml, and no blood transfusion was needed. Postoperative pathologic examination indicated low-grade infiltrative urothelial carcinoma. The patient exhausted on the 3th post-operative day, had off-bed activities on the 4th post-operative day, and was discharged on the 28th post-operative day. （2） There were more than 400 patients underwent RARC worldwide. The RARC group had marginally lower complications rate （31% vs. 28% ） and numbers of lymph node dissection （ 18.2 vs. 13.0） than the LCR group. There were significant differences in the duration of operation （285.7 mins vs. 372. 0 mins）,intraoperatie blood loss （286 ml vs. 556.0 ml） and mean days of hospitalization （8.6 d vs. 13.0 d） between the RARCA and the LCR groups. Conclusion RARC is a novel and effective procedure for the treatment of bladder cancer. As there is only a relatively small sample around the world and httle experience on this procedure can be referred, more clinical practice with RARC and high quality research with long-term follow-up are needed to update the database and evaluate its effectiveness and safety.