机器人辅助保留前列腺的根治性膀胱切除-原位回肠新膀胱术初步经验(附1例报告)

Preliminary experience in robot-assisted prostate sparing cystectomy with orthotopic ileal neobladder(A case report)

目的:探讨达芬奇机器人辅助保留前列腺的根治性膀胱切除-原位回肠新膀胱术的初步经验。方法:回顾性分析2023年7月上海交通大学医学院附属第九人民医院1例行达芬奇机器人辅助保留前列腺的根治性膀胱切除-原位回肠新膀胱术的临床数据、手术、病理、预后等资料。结果:手术时间约360 min,术中估计出血量约300 mL,术后住院时间9 d,术中及术后未见严重并发症发生。术后病理结果提示低级别乳头状尿路上皮癌,肿瘤局部浸润至黏膜固有层,盆腔淋巴结未见转移,无切缘阳性。远期效果还需要继续长期跟踪随访。结论:筛选合适的患者,达芬奇机器人辅助保留前列腺的根治性膀胱切除-原位回肠新膀胱术可在良好瘤控的前提下,保留男性患者的勃起功能、射精功能、自主生殖功能以及尿控功能,从而提高患者术后的生活质量,然而未来需要多中心、随机对照研究来进一步验证。

Objective:To discuss the initial experience of da Vinci robot-assisted prostate sparing radical cys-tectomy-orthotopic ileal neobladder.Methods:We retrospectively analysed the clinical data,operation,pathology,and prognosis of a case of da Vinci robot-assisted prostate sparing radical cystectomy-orthotopic ileal neobladder in the Shanghai Ninth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine in July 2023.Results:he operation time was about 360 minutes.The estimated intraoperative blood loss was about 300 mL.The postoperative hospital stay was 9 days.No serious complications occurred during or after the operation.Postoper-ative pathological results showed low-grade papillary urothelial carcinoma,with local infiltration of the tumor into the mucosa lamina propria,without metastasis to the pelvic lymph nodes or positive margins.Long-term effects still need following up for a long time.Conclusion:For screened suitable patients,da Vinci robot-assisted prostate sparing radical cystectomy-orthotopic ileal neobladder could preserve the erectile function,ejaculation function,autonomous reproductive function and urinary control function of male patients under the premise of good tumor control,thereby improving the quality of life of patients after surgery.However,multi-center,randomized controlled studies are needed for further verification in the future.