机器人全腔内studer原位新膀胱术手术经验总结及临床疗效分析(附单中心10例报道)

Clinical experience and efficacies of robotic intracorporeal studer orthotopic neobladder: a single center reports with 10 cases

目的:总结机器人全腔内studer原位新膀胱术(RISON)的手术经验和临床疗效。方法:回顾性分析2018年4-8月在中国人民解放军总医院接受RISON手术共10例患者的基线资料及围手术期结果,并对RISON手术术前准备、机器人位置、穿刺套管位置的设计进行描述,并对其中关键步骤和技术要点进行经验总结,同时对所有患者进行术后随访,统计术后膀胱容量、控尿情况,性功能情况及发生的近期和远期并发症,进一步评估临床治疗效果。结果:所有10例手术均成功完成,无一例中转开放手术或更改尿流改道术式,中位手术时间420 min(300～540 min),术中出血量250 mL(100～800 mL),排气时间3 d(2～4 d),术后下床活动时间2 d(1～7 d),耐受进食时间5 d(4～8 d)。患者术后病理分期:6例T_2N_0M_0,4例T_1N_0M_0(膀胱肿瘤电切术后),切缘均为阴性,1例患者合并前列腺腺癌,淋巴结清扫20～25个。2例患者发生近期并发症(≤30 d),9例患者发生远期并发症(>30 d),Clavien Ⅰ级3例,Clavien Ⅱ级5例,Clavien Ⅲ级1例,再入院率50%。单从手术疗效分析看,患者术后中位膀胱容量300 mL(0～400 mL),其中1名女性患者发生尿失禁,其余9名男性患者白天均能控制排尿,夜晚需定时排尿(平均4次),2例保留性神经患者术后均能获得较为满意的勃起,性功能评分15分以上。无一例患者术后死亡,平均随访6个月(3～7个月)。结论:机器人全腔内studer原位新膀胱术是一种安全可行的尿流改道术式,术后大部分患者均能获得满意的疗效。

Objective:To summarize the clinical experience and efficacies of robotic intracorporeal studer orthotopic neobladder(RISON).Method:The baseline and perioperative data of 10 patients undergoing RISON in our single center between January to August in 2018 were reviewed.The preparation,manipulation of robot and the location of trocars were described.The tips and tricks of key procedures and techniques were introduced.Meanwhile,further follow-up was also conducted to evaluate the clinical effect,including bladder capacity,urinary controlling,sexual function,short-term and long-term complications.Results:All the RISONs were successfully performed without conversion to open surgery or changing urinary diversion.Nine men and 1 woman with a median age of 61 years old(range 26-69)and BMI of 25(20.3-33.8)were included.Median operation time was 420 min(range 300-540 min),median blood loss was 250 mL(range 100-800 mL),time to return of flatus 3 days(range 2-4 days),full ambulation 2 days(range 1-7 days),full tolerance 5 days(range 4-8 days).TNM stage:T2N0M0 6 cases,T1N0M0 4 cases(after transurethral resection of bladder tumor).Surgical margins were negative in all cases.One patient had prostate cancer meantime.The lymph nodes’number of each case was 20-25.Overall,2 patients experienced short-term complication(within 30 days),and 9 patients encounted long-term complication(out of 30 days),including Clavien GradeⅠ3 cases,GradeⅡ5 cases and GradeⅢ1 case.From the perspective of surgical effects,full bladder volume was 300 mL(range 0-400 mL).Except 1 female patient can’t control urination,the remaining 9 male patients obtained micturition control during the day and regular micturition during night.Two cases of reserved nerve patients obtained relatively satisfactory erections after surgery with sexual function score above 15 points.No deaths occurred within an average follow-up period of 6 months(range 3-7 months).Conclusion:RISON is a safe and feasible method for urinary diversion.Most patients can get satisfactory curative effect after operation.