机器人辅助全腹腔镜下根治性膀胱切除加原位回肠新膀胱术

Totally robot-assisted laparoscopic radical cystectomy with orthotopic ileal neobladder

目的:总结采用da Vinci S机器人系统完成机器人辅助全腹腔镜根治性膀胱切除（totally robotic-assisted laparoscopic radical cystectomy,tRARC）加原位回肠新胱术的临床技术经验和疗效。方法:回顾分析2012年3月2015年7月接受机器人辅助腹腔镜根治性膀胱切除加原位回肠新膀胱术的膀胱尿路上皮癌患者9例。均为男性,平均年龄54（3764）岁。术前肿瘤活检病理诊断为浸润性或高级别膀胱尿路上皮癌,术前检查均未发现有其他邻近脏器浸润、盆腔淋巴结转移或远处转移,临床分期均低于T3N0M0。9例患者全部为全麻下行tRARCC加腔内原位回肠新膀胱术。结果:9例患者手术均获成功。手术平均时间520（360780）min;平均出血量555（3001200）ml;平均淋巴结清扫数目为13（423）枚。术后23 d下地活动,34d肠功能恢复,术后平均住院时间20（1032）d。患者术后1个月行膀胱造影确定无吻合口漏后拔除尿管和双侧输尿管支架管。术后随访时间平均28（141）个月,人组所有病例肾功能均正常,尿控较满意,无肾积水。结论:根据初期的手术操作过程和随访结果,tRARC加原位新膀胱术在临床上是可行的。更多的操作经验、规范的手术流程和长期和随机的对照研究将有助于对这一技术进行评估和推广。

Objective:To summarize the clinical operative technique and effect of totally robotic-assisted laparoscopic radical cystectomy(tRARC) with orthotopic ileal neobladder by da Vinci surgical system.Methods:From Mar 2012 to July 2015,9 male patients of bladder urothelial carcinomas underwent tRARC with orthotopic ileal neobladder were enrolled.The mean age was 54 years(ranged from 37-64 years).All patients were diagnosed preoperative with muscle-invasive or high-grade bladder urothelial carcinomas in cystoscopic biopsy.There were no adjacent organ infiltration found,pelvic lymph node metastases or distant metastasis on preoperative examinations,and the clinical stage were all below T_3N_0M_0.General anesthesia was administered for tRARC with intracorporeal orthotopic ileal neobladder to all patients.Results:All 9 cases were successful.The average operation time was 520min(ranged from 368-780 min) with average blood loss of 555ml(300 to 1 200 ml),and the average number of lymph nodes was13(ranged from 4 to 23).All patients resumed ambulation on postoperative 2 to 3 days,and bowel function recovered on either postoperative day 3 or 4.The average length of hospital stay was 20d(ranged from 10-32 d).One month after operation a cystogram was performed to confirmed watertight healing.During the follow up of 3-43months(mean 30 months).All of the patients have normal renal functions and satisfactory urinary continence without hydronephrosis.Conclusions:According to the initial surgery procedure and the results of the initial operation,the tRARC with intracorporeal orthotopic ileal neobladder by da Vinci surgical system is feasible in clinic.More operational experience,standard surgical procedures,long-term and randomized controlled studies will be helpful to evaluate and promote the technology.