3D腹腔镜与传统2D腹腔镜在保留性神经根治性膀胱切除手术中的比较研究

Comparative study between 3D imaging system for laparoscopic nerve-perserving radical cystectomy and 2D imaging system

目的：评价3D腹腔镜在保留性神经膀胱全切术中的应用以及与传统2D腹腔镜的差别与优势。方法：收集2012～2015年112例行保留性神经膀胱全切及开放下回肠代膀胱术后患者的资料,其中3D腹腔镜作为辅助方式的有34例,我们通过比较术中淋巴结清扫数量及时间,闭孔神经保留率,腹腔镜下膀胱摘除手术时间,腹腔镜手术出血量,患者围手术期并发症,术后勃起功能恢复情况以及术者术后疲劳评分情况来评价3D腹腔镜相对传统2D腹腔镜的优势。结果：与传统2D腹腔镜相比3D腹腔镜有更少的腹腔镜下膀胱摘除手术时间、患者术后勃起功能得到更好的保留以及术后术者眼睛疲劳指数更低。在单因素分析及多因素分析中术前IIEF-5评分、年龄〉60岁以及使用3D腹腔镜作为辅助技术与IIEF-5评分独立相关。结论：相对于传统2D腹腔镜而言,3D腹腔镜在保留性神经膀胱全切手术中能有效缩短腹腔镜下膀胱切除手术时间、降低术者手术疲劳的程度以及能更好的保留血管神经束,更有利于患者术后勃起功能的保留。

Objective：To compare the clinical effectiveness between three-dimensional（3D）and two-dimensional（2D）laparoscopic imaging systems for nerve-perserving radical cystectomy with pelvic lymph node dissection.Method：From 2012 to 2015,a total of 112 patients,who underwent laparoscopic nerve-perserving radical cystectomy with ileal neobladder for clinically localized bladder cancer,have been retrospectively studied in our center.Thirty-four patients were operated with assistance of 3Ddisplay system,while others with traditional 2D laparoscopy.Their clinical data were evaluated and compared including the number of dissected lymph nodes,time of bilateral pelvic lymph node dissection,rate of injury of major vessels or nerves,laparoscopic operative time,blood loss,perioperative complications,postoperative erectile function and surgeons＇ visual comfort.Result：Compared with traditional 2Dlaparoscopy,patients treated with 3Dlaparoscopy have less laparoscopic operative time,more favorable erectile function preserving,and the surgeons complained of less visual fatigue.In univariate and multivariable analysis,age more than 60 years,the assistance of 3Ddisplay system and preoperative IIEF-5score were independently associated with postoperative IIEF-5score.Conclusion：Compared with traditional 2Dlaparoscopy,3Dlaparoscopy is superior in decreasing operation time,preserving nerve vessel bundles so as to achieve erectile function retention.Also,such technique provides more visual comfort for surgeons.