机器人辅助腹腔镜腹膜后淋巴结清扫术13例报告

Thirteen cases report of robot assisted laparoscopic retroperitoneal lymph node dissection

目的：探讨机器人辅助腹腔镜腹膜后淋巴结清扫术（RA-RPLND）的手术技巧和优势。方法：2014年2月-2015年6月,行RA-RPLND治疗13例睾丸肿瘤根治术后非精原细胞肿瘤（NSGCT）患者。平均年龄31.8（24-46）岁,左侧8例,右侧5例。总结手术时间、术中出血量、围手术期并发症,随访肿瘤转归及性功能恢复情况。结果：手术均获成功,无中转病例。手术时间128.3（100-150）min;术中出血量108.3（60-400）ml;无输血;术后引流4.4（4-8）d;术后2（1-4）d肠道功能恢复;平均清扫淋巴结19.6（15-27）个,阳性3个（1.2%,3/255）。术后淋巴漏2例,经保守治疗后治愈。随访15（6-28）个月,无死亡病例。术后1.5（1-6）个月恢复性功能,逆行射精1例。1例术后6个月出现右肺上叶及肺门转移,行全身化疗3个疗程,随访至今无复发。结论：RPLND是早期NSGCT的重要诊断和治疗方法。RA-RPLND具有其独特的优势,高清的3D视野和精确的操作能够更好地保留神经,减少副损伤,值得推广和应用。

Objective：To evaluate the surgical techniques and advantages of robot assisted laparoscopic retroperitoneal lymph node dissection（RA-RPLND）.Method：Thirteen patients with non-seminoma germ cell tumor（NSGCT）who underwent radical orchiectomy were performed RA-RPLND using da Vinci surgical system from February 2014 to June 2015.The mean age was 31.8（24-46）yrs.Tumors of eight cases were found left,and five were right.Surgical duration,estimated blood loss and perioperative complications were analyzed.Result：All procedures were performed successfully without conversion to open surgery.The mean surgical duration was128.3（range,100-150）min,and the mean estimated blood loss was 108.3（range,60-400）ml.The average drainage time was 4.4（range,4-8）days,and the intestinal function recovery time was 2（range,1-4）days.The average lymph node yield was 19.6（range,15-27）,3（1.2%,3/255）were found positive.Lymphorrhagia occurred in two cases,and they were cured after 1-week conservative treatment.No one was dead after an average15-month follow-up period.Sexual functional recovery was 1.5（range,1-6）months.One case was found retrograde ejaculation.One case was found metastases of superior lobe of right lung and hilum six months postoperatively.However,he was cured after 3-round chemotherapy.Conclusion：RPLND is the main therapy for diagnosis and treatment of NSGCT.The da Vinci surgical system improves the safety and accuracy of RPLND.Surgeons can perform a meticulous and complete modified nerve-sparing RPLND with lower complications in 3-D visual field.