机器人辅助腹腔镜技术治疗泌尿外科疾病的临床效果

Preliminary application experience of urological diseases by robotic assisted laparoscopy

目的对比分析部分泌尿外科疾病应用机器人辅助技术与腹腔镜手术治疗的效果,初步总结临床经验,扩大机器人辅助腹腔镜技术在泌尿外科疾病的应用范围。方法 2014年9月至2015年1月,总计155例患者纳入研究范围,包括膀胱癌(43例)、前列腺癌(51例)、肾肿瘤(37例)、肾上腺肿瘤(13例)、肾盂输尿管连接部狭窄(11例)。其中,机器人辅助腹腔镜技术治疗泌尿系疾病79例,传统腹腔镜手术76例,分别就手术时间、出血量、术后肠道通气进食时间、术后住院天数等进行比较。结果两组手术均获成功,疗效无差异。机器人组中,保留肾单位肾部分切除、肾盂输尿管连接部成型、肾上腺占位切除手术时间明显短于腹腔镜组:(65.42±22.51)min vs.(92.63±13.20)min、(67.75±12.53)min vs.(90.35±18.53)min、(78.43±25.44)min vs.(95.43±28.23)min;膀胱癌根治、保留肾单位肾部分切除、肾盂输尿管连接部成型术中出血量明显少于腹腔镜组:(185.33±88.35)mL vs.(270.58±102.83)mL、(64.54±20.44)mL vs.(120.41±45.13)、(39.34±19.41)mL vs.(63.51±21.25)mL;前列腺癌根治、膀胱癌根治术后肠道功能恢复时间明显短于腹腔镜组(d):(2.52±0.84)/(4.53±1.85)、(4.02±1.33)/(5.21±1.52);前列腺癌根治、肾盂输尿管连接部成型术后住院日明显少于腹腔镜组:(7.12±2.20)d vs.(18.01±4.01)d、(8.53±4.54)d vs.(10.53±3.22)d;前列腺癌根治手术时间明显长于腹腔镜组:(162.31±21.03)min vs.(130.23±30.21)min。结论机器人辅助腹腔镜技术应用于泌尿外科疾病,解剖精细、重建精准,且损伤小、痛苦少、康复快、住院时间短。随着不断训练、技术熟练水平的提高及相关操作器械的更新,部分手术时间的缩短不容置疑,将为泌尿外科疾病治疗提供更好的平台。

Objective To comparatively analyze the application of robotic assisted laparoscopy and traditional laparosco- py surgery in some urologic diseases, to summarize clinical experience, and to expand the application of robotic assisted laparos- copy in urological diseases. Methods A total of 155 cases treated during Sept. 2014 to Jan. 2015 were involved, including 43 cases of bladder cancer, 51 cases of prostate cancer, 37 cases of renal carcinoma, 13 cases of adrenal gland tumor and 11 cases of pelvis ureter joint stricture. Robotic assisted laparoscopy surgery was performed in 79 cases and laparoscopy surgery in 76 ca- ses. The operation time, blood loss, postoperative gastrointestinal ventilation, and hospital stay were compared. Results All operations were successfully completed and the therapeutic effects of the two different surgical methods were the same. The operation time in the robot group was significantly shorter than in the laparoscopy group in partial nephrectomy, pyeloplasty and adrenalectomy （min） ： （65. 424-22.51）/（92.63＋ 13.20）, （67.75~ 12.53）/（90.35~ 18.53）, and （78.43＋25.44）/（95.43 4-28.23）. Blood loss in the robot group was significantly less than in the laparoscopy group in radical cystectomy, partial ne- phrectomyandpyeloplasty （mL）： （185.33±88.35）/（270.58±102.83）, （64. 54±20.44）/（120.41±45.13）, and （39.34± 19.41）/（63.51± 21.25）. Postoperative intestinal function recovery time in the robot group was significantly shorter than in the laparoscopy group in prostatectomy, radical cystectomy （d） ： （2.52±0.84）/（4.53±1.85）, and （4.02±1.33）/（5.21± 1.52）. The postoperative hospital stay of the robot group was significantly shorter than that of the laparoscopy group in prostatectomy andpyeloplasty （d）： （7.12±2.20）/（18.01±4.01）, （8.53±4.54）/（10.53± 3.22）. The operation time for the robot group was significantly longer than for the laparoscopy in prostatectomy （min） ： （162.31±21.03）/（130.23±30.21）. Oonclusions Robotic assisted laparoseopy technology is recommended in the treatment of urological diseases for its direct approach, fine anatomy and precise reconstruction, less damage, less pain, rapid recovery and short hospital stay. With ongoing training and constantly updating technical skills and equipment, robotic assisted laparoscopy technology will shorten the operation time, and will provide a better platform for urologic disease treatment.