机器人辅助腹腔镜、传统腹腔镜和开放手术3种膀胱癌根治性全膀胱切除加回肠膀胱术的围手术期疗效比较

Comparison of perioperative outcomes of robot-assisted laparoscopic,traditional laparoscopic and open radical cystectomy with ileal conduit

目的对比机器人辅助腹腔镜、传统腹腔镜以及开放根治性全膀胱切除加回肠膀胱术的围手术期情况。方法回顾性分析2009年1月至2018年12月复旦大学附属中山医院泌尿外科单手术组开展的根治性全膀胱切除加回肠膀胱术248例,其中机器人辅助腹腔镜87例、传统腹腔镜32例、开放手术129例。比较3组性别、年龄、体重指数(body mass index,BMI)、合并慢性病、手术时间、术中输血率、术后输血率、入监护室率、术后红细胞下降值、术后血红蛋白下降值、术后白蛋白下降值、术后肌酐升高值、术后住院时间、住院总费用以及肠梗阻、感染等并发症发生率的差异。结果 248例手术均获成功,无中转其他手术方式。3组的年龄、性别、BMI、高血压病史、糖尿病病史、心脏病病史等方面比较,差异均无统计学意义。机器人手术组在手术时间、术后红细胞下降值、血红蛋白下降值、白蛋白下降值方面均显著小于另两组,在术后住院时间、术中输血率方面,机器人手术组也显著小于开放手术组(P<0.05);传统腹腔镜组在术后红细胞下降值、血红蛋白下降值方面显著小于开放手术组(P<0.05)。在住院总费用方面机器人手术组显著高于另两组(P<0.05)。在术后并发症方面,虽然机器人手术组发生率低于传统腹腔镜组和开放手术组,但差异无统计学意义。结论围手术期机器人辅助腹腔镜根治性全膀胱切除加回肠膀胱术较传统腹腔镜手术和开放手术具有手术时间短、创伤小和术后恢复快等优势,在经济可行的条件下,是治疗肌层浸润性膀胱癌的首选手术方法。

Objective To compare the perioperative outcomes of robot-assisted laparoscopic radical cystectomy(RARC),conventional laparoscopic radical cystectomy(LRC),and open radical cystectomy(ORC). Method We retrospectively analyzed data of 248 patients who underwent radical cystectomy and ileal conduit in single operation group,Department of Urology,Zhongshan Hospital of Fudan University from Jan.2009 to Dec.2018,including 87 cases of robot-assisted laparoscopic surgery,32 cases of traditional laparoscopic surgery,and 129 cases of open surgery.The gender,age,body mass index(BMI),concomitant chronic diseases,operation time,intraoperative blood transfusion rate,postoperative blood transfusion rate,ICU rate,postoperative red blood cell decline,postoperative hemoglobin decline,postoperative albumin decline,postoperative creatinine elevation,postoperative hospital stay,total hospitalization costs,and complication rates were compared. Results All 248 cases of surgery were successful without conversion to other surgical methods. There were no significant differences in age,gender,BMI,history of hypertension,diabetes,and heart disease between the three groups. The robotic surgery group was significantly lower than the laparoscopic group and the open group in terms of operation time,postoperative red blood cell decline,hemoglobin decrease,and albumin decrease(P<0.05).Robotic surgery was also significantly lower than open surgery in terms of postoperative hospital stay and intraoperative blood transfusion rate(P<0.05). The laparoscopic group was significantly lower than the open group in terms of red blood cell decline and hemoglobin decline(P<0.05).The total hospitalization cost of robotic surgery was significantly higher than that of the laparoscopic and open groups(P<0.05).In terms of postoperative complications,although the incidence of robotic surgery was lower than that of the laparoscopic group and the open group,the difference was not statistically significant. Conclusions Robot-assisted laparoscopic radical cystectomy and ileal bladder surgery has the advantages of shorter operation time,less trauma and quicker recovery than traditional laparoscopic and open surgery. Under economically feasible conditions,it is the preferred surgical method for muscle invasive bladder cancer.