机器人辅助根治性膀胱切除加体内尿流改道术的临床应用

Clinical application of robot-assisted radical cystectomy and intracorporeal urinary diversion

目的分析总结机器人辅助根治性膀胱切除(RARC)加体内尿流改道术(ICUD)的应用经验,探讨其可行性及疗效。方法回顾性分析2016年12月至2019年12月南京大学医学院附属鼓楼医院62例施行RARC+ICUD手术患者的临床资料。其中男性52例,女性10例;年龄为46~81岁,平均(65.51±8.57)岁。手术范围包括膀胱切除和盆腔淋巴结清扫,然后在全腔镜下行体内回肠膀胱术或原位新膀胱术。根据Clavien-Dindo评分系统判定术后90 d内的并发症发生情况及其严重程度。结果62例患者手术均顺利完成,回肠膀胱术与原位新膀胱术的手术时间分别为405~560(482.50±77.50)min、490~550(520.00±58.17)min;术中估计失血量分别为400~1200(800.00±400.00)mL、400~600(500.00±211.48)mL;术后住院时间分别为13~32(22.50±9.50)d、9~25(17.00±8.73)d。术后病理结果为高级别尿路上皮癌46例、原位癌2例和高级别尿路上皮癌伴原位癌14例。7例存在淋巴结转移,手术切缘均为阴性。26例术后出现不同级别的并发症,主要为尿路感染和肠梗阻,其中Clavien-Dindo分级≥3级的有4例。随访6~44(17.31±8.22)个月,5例出现远处转移,1例局部复发,4例死亡。结论RARC+ICUD具有创伤小、安全性高、疗效明确的优点,是一种可选用于膀胱癌患者的手术治疗方式。

Objective To explore the feasibility and efficacy of robot-assisted radical cystectomy(RARC)with intracorporeal urinary diversion(ICUD)in the treatment of bladder cancer.Methods The clinical data of 62 patients who underwent RARC with ICUD during Dec.2016 and Dec.2019 were retrospectively reviewed.The patients included 52 males and 10 females,with an average age of 65.51 years(ranging from 46 to 81).The surgery included cystectomy,pelvic lymph node dissection,and intracorporeal construction of ileal conduit or neobladder.Postoperative complications within 90 days were evaluated with the Clavien-Dindo classification.Results All operations were successful.In ileal bladder and orthotopic neobladder,the operation time of were 405-560(482.50±77.50)min and 490-550(520.00±58.17)min,respectively;the estimated blood loss were 400-1200(800.00±400.00)mL and 400-600(500.00±211.48)mL,respectively.The postoperative hospital stay were 13-32(22.50±9.50)d and 9-25(17.00±8.73)d,respectively.This cohort of patients included 46 cases of high-grade urothelial carcinoma,2 cases of carcinoma in situ and 14 cases of high-grade urothelial carcinoma with carcinoma in situ.There were 7 cases with lymph node metastasis.The surgical margins were all negative.Postoperative complications such as urinary tract infection and ileus occurred in 26 cases,including 4 cases of Clavien-Dindo grade≥3.During the follow-up of 6-44(17.31±8.22)months,there were 5 cases of distant metastasis,1 case of local recurrence and 4 cases of death.Conclusion RARC with ICUD is an alternative minimally invasive option for the treatment of bladder cancer.