机器人辅助腹腔镜体内原位U形回肠新膀胱术的临床疗效观察及尿动力分析

Clinical observation and urodynamic analysis of robotic-assisted radical cystectomy with totally intracorporeal orthotopic U-shaped ileal neobladder

目的探讨采用da Vinci Xi机器人系统完成机器人辅助腹腔镜下根治性膀胱切除(RARC)加体内构建原位U形回肠新膀胱术的临床疗效,并结合术后尿动力分析评价该术式对排尿的影响及可能机制。方法以2020年6月至2021年3月连续进行的8例机器人辅助腹腔镜下根治性膀胱切除+体内原位U形回肠新膀胱术患者为研究对象,其中男7例,女1例,年龄63(18)岁,极高危非肌层浸润膀胱癌1例,肌层浸润性膀胱癌7例,术后随访时间为3~12个月。记录随访期间患者的尿控恢复、分肾功能、上尿路影像学结构改变以及肿瘤学预后。结果8例手术均成功完成,并发症发生率37.5%,术后3个月日间完全尿控率87.5%,夜间功能性尿控率75.0%,术后6个月尿动力分析示:最大尿流率和平均尿流率分别为19.8(3.97)ml/s、5.05(0.94)ml/s,最大尿道压81.5(28.75)cm H_(2)O,新膀胱顺应性26.5(12.75)ml/cm H_(2)O。结论RARC术后实施体内原位U形回肠新膀胱术是可行的,具有可重复性,是一种疗效确切、尿控恢复理想的膀胱根治性切除术后新膀胱替代方案。

Objective To explore the clinical efficacy of robotic-assisted laparoscopic radical cystectomy(RARC)with totally intracorporeal orthotopic U-shaped ileal neobladder by Da Vinci Xi surgical system.Furthermore,the effect of this procedure on urination and possible mechanism was evaluated based on postoperative urodynamic analysis.Methods A group of 8 consecutive patients underwent robotic-assisted laparoscopic radical cystectomy and intracorporeal orthotopic U-shaped ileal neobladder surgery from June 2020 to March 2021 was enrolled in the study,including 7 males and 1 female and the age was 63(18)years.One case was with very high risk non-muscle invasive bladder cancer(NMIBC),and 7 cases were with muscle invasive bladder cancer(MIBC).The postoperative follow-up time was 3-12 months.The patients'urinary control recovery,renal function,changes in the imaging structure of the upper urinary tract,and oncology prognosis during the follow-up period were recorded.Results All the procedures were completed successfully.The complication rate was 37.5%.Seven cases(87.5%)had complete urinary control during the day and 6 cases(75.0%)had functional urinary control at night 3 months after operation.Urodynamic examination at 6 months after operation showed that the maximum urine flow rate and average urine flow rate were 19.8(3.97)ml/sand 5.05(0.94)ml/s respectively.The maximum urethral pressure were 81.5(28.75)cm H_(2)O and neobladder compliance were 26.5(12.75)ml/cm H_(2)O.Conclusions Robotic-assisted laparoscopic radical cystectomy(RARC)with totally intracorporeal orthotopic U-shaped ileal neobladder is available with a good reproducibility.It is a new bladder replacement with good effect and ideal urinary control recovery after radical cystectomy.