机器人辅助腹腔镜儿童膀胱横纹肌肉瘤切除术的疗效分析

Preliminary experience of robotic-assisted laparoscopic surgery for bladder rhabdomyosarcoma in children

目的探讨机器人辅助腹腔镜儿童膀胱横纹肌肉瘤切除术的可行性与安全性。方法回顾性分析2018年7月至2019年9月解放军总医院第七医学中心附属八一儿童医院4例行机器人辅助腹腔镜儿童膀胱横纹肌肉瘤切除术患儿的临床资料。均为男性,年龄平均68(11~122)个月。膀胱镜检查见肿瘤位于膀胱前壁1例,膀胱后壁1例,膀胱三角区及后尿道1例,膀胱弥漫性分布并累及后尿道1例。4例均经PET-CT检查证实无淋巴结及远处转移。4例均经膀胱镜活检确诊后,行术前化疗并评估疗效。2例化疗疗效不佳,加行术前放疗,在尿道膜部无肿瘤残留后行机器人辅助腹腔镜手术。1例肿瘤弥漫性分布于全膀胱的患儿行根治性膀胱切除、乙状结肠原位新膀胱及双侧输尿管Politano-Leadbetter再植术;3例行膀胱部分切除术,其中1例行输尿管膀胱再植术。结果4例手术均顺利完成,无中转开放病例。平均手术时间189(104~316)min,平均出血量为32.5(20~50)ml。肿瘤平均最大径为4.48(2.7~6.0)cm。术后病理均为胚胎型横纹肌肉瘤;1例切缘阳性,3例切缘阴性。所有患儿术后均未发生Clavien-DindoⅢ级以上并发症,平均住院时间18(14~24)d。出院后平均随访时间为14.7(7~21)个月。4例术后予VAC方案行8周期化疗,切缘阳性患儿加行36Gy放疗。4例患儿至末次随访均无肿瘤复发。结论机器人辅助腹腔镜儿童膀胱横纹肌肉瘤切除术创伤小、恢复快,无严重并发症发生。长期肿瘤控制及尿控情况仍有待于进一步随访研究。

Objective To evaluate the safety and feasibility of robotic-assisted laparoscopic resection of bladder rhabdomyosarcoma.Methods A retrospective study was performed in 4 children underwent robotic-assisted surgery for bladder rhabdomyosarcoma from July 2018 to September 2019 in our hospital.The perioperative information and short time outcomes were collected.All the four patients were male.The average age of these patients was 68 months(from 11 to 122 months).After cystoscopy biopsy was conducted,preoperative chemotherapy was carried out.Preoperative radiotherapy was also added depends on the tumor response,then robotic-assisted surgery was performed.Radical cystectomy and orthotopic neobladder reconstruction with bilateral ureter reimplanataion were carried out for the bladder was widely occupied case.Bladder preserving surgery was performed for the other three localized cases.Results All of the four operations have been conducted successfully without conservation to open surgery.The mean operative time was 189(104-316)min while the mean estimated blood loss was 32.5(20-50)ml.The mean tumor diameter was 4.48(2.7-6.0)cm.According to the pathological results,all of the four cases were diagnosed as embryonal rhabdomyosarcoma.One case had positive margin while other three cases had negative margins.No complication more than Clavien-Dindo gradeⅢwas observed.The mean length of hospital stay was 18(14-24)days and the mean follow-up time was 14.7(7-21)months.Postoperative chemotherapy was carried out according to the protocol of IRS low risk group for all cases(VAC,eight cycles).Postoperative radiotherapy was conducted for the case with positive margin.No recurrence was recorded during the follow-up period.Conclusions Robotic-assisted laparoscopic technique for the treatment of bladder rhabdomyosarcoma in children is safe and feasible.