机器人辅助腹腔镜手术650例的临床经验:来自上海瑞金医院的报告

Single center experience of 650 cases of robot-assisted laparoscopic surgeries from Shanghai Ruijin Hospital

目的：汇报我院650例机器人手术的治疗结果,总结其临床经验。方法：我院于2010年3月-2015年10月共行达芬奇机器人辅助腹腔镜泌尿外科手术650例,其中上尿路手术484例,包括肾上腺切除术183例,根治性肾切除术46例,肾部分切除术130例,肾输尿管全长切除术13例,上尿路切开取石及上尿路成形术93例,马蹄肾峡部离断术1例,多囊肾去顶17例,腹膜后淋巴结清扫1例。下尿路手术166例,其中根治性前列腺切除术122例,根治性膀胱切除术25例,膀胱部分切除术11例,前列腺剜除术4例,脐尿管囊肿切除术3例,膀胱阴道瘘修补1例。结果：上尿路手术中,1例肾上腺手术因术中机械故障中转开放手术;另1例因术后继发性出血,二次开放手术止血。所有下尿路手术均获得成功。结论：泌尿外科的绝大部分手术适应机器人辅助腹腔镜手术,尤其适合肾盂输尿管成形术、肾部分切除术、根治性前列腺切除术和根治性膀胱切除术。对于大体积的肾上腺切除术、大体积的单纯前列腺剜除术以及保留神经的腹膜后淋巴结清扫术也有优势。相对于上尿路手术,下尿路手术的优势更为明显。

Objective：To report the results and experience of 650 cases of robot-assisted laparoscopic surgeries from our department.Method：From March 2010 to October 2015,650 cases of robot-assisted laparoscopic surgeries were performed in our department including 484 cases with upper urinary tract and 166 cases with lower urinary tract.Upper urinary tract operations included 183 adrenalectomies,46radical nephrectomies,130 partial nephrectomies,13 nephroureterectomies,93lithotomies and pyeloureteroplasties,1isthmus disconnection for horseshoe kidney,17 cystectomies for polycystic disease and 1retroperitoneal lymphadenectomy.Lower urinary tract operations included 122 radical prostatectomies,25 radical cystectomies,11 partial cystectomies,4simple prostatectomies,3excisions of urachal cyst and 1vesicovaginal fistula repair.Result：Two of upper urinary tract operations must be converted to open surgery because of mechanical breakdown during the operation and postoperative hemorrhage.All lower urinary tract operations were successful.Conclusion：The majority of urological operations are suitable for robotic surgeries especially pyeloureteroplasty,partial nephrectomy,radical prostatectomy and radical cystectomy.The superiority of robotic surgery can also be demonstrated in great-diameter adrenalectomy,simple prostatectomy for large volume prostate,and nerve-sparing retroperitoneal lymphadenectomy.Compared with that of upper urinary tract operation,advantages of surgeries in lower urinary tract are more obvious.