完全机器人辅助腹腔镜回肠原位膀胱构建的手术技巧

Surgical Skills of Totally Intracorporeal Robot-assisted Laparoscopic Orthotopic Ileal Neobladder

目的探讨完全机器人辅助腹腔镜回肠原位膀胱构建术的手术技巧。方法2021年8~12月我科对6例膀胱癌行机器人辅助腹腔镜膀胱全切术,完全在腹腔内进行回肠原位膀胱重建。遵循“先吻合尿道,后构建膀胱”的原则,通过交叉折叠的方式制作改良Studer原位膀胱。结果6例手术均顺利完成,无中转腹腔镜或开放手术。手术时间346~498 min,平均393 min,其中回肠原位膀胱构建时间160~240 min,平均185 min。术中出血量100~600 ml,平均308 ml,无围手术期输血。术后1~2 d通气,第2天下地活动,3~6 d恢复半流食,4~6 d拔除腹腔引流管,7~9 d出院。术后30 d内未见严重并发症发生。6例随访3.5~7个月,平均5.6月,均存活,无复发或转移,5例可完全控尿,1例为社交控尿状态。结论完全机器人辅助腹腔镜回肠原位膀胱构建安全、可行,熟悉手术步骤,重视操作细节,提升机器人操作技巧是顺利开展此手术的关键。

Objective To explore the surgical skills of totally intracorporeal robot-assisted laparoscopic orthotopic ileal neobladder.Methods From August 2021 to December 2021,robot-assisted laparoscopic radical cystectomy with totally intracorporeal orthotopic ileal neobladder was performed in 6 bladder cancer patients.Following the principle of“urethral anastomosis first,bladder construction second”,we made the modified Studer orthotopic neobladder by cross-folding ileum.Results All the operations were successfully completed without conversion to laparoscopy or open surgery.The average operation time was 393 min(range,346-498 min),of which the construction time of orthotopic ileal neobladder was 185 min(range,160-240 min).The intraoperative blood loss was 308 ml(range,100-600 ml),and there was no perioperative blood transfusion.The patients farted after 1-2 days,ambulated on the second day,recovered semi liquid food after 3-6 days,removed abdominal drainage tube after 4-6 days,and were discharged 7-9 days later.No serious complications occurred within 30 days after operation.With an average follow-up of 5.6 months(range,3.5-7 months),all the patients survived without recurrence and metastasis.Five patients could complete urinary control,and one patient was in social urinary control.Conclusions Totally intracorporeal robot-assisted laparoscopic orthotopic ileal neobladder is a safe and feasible surgical method.Being familiar with the surgical steps,paying attention to the details of operation and improving robotic operation skills are important factors for the smooth implementation of this operation.