摘要
目的探讨机器人辅助全腹腔镜下“紫砂壶型”原位回肠新膀胱患者的尿控和肿瘤学预后。方法以2017年5月至2019年6月连续进行的10例机器人辅助根治性膀胱切除+回肠原位新膀胱术患者为研究对象,男9例,女1例,年龄(63±11)岁,极高危非肌层浸润膀胱癌5例,肌层浸润性膀胱癌5例;术后随访时间为12~37个月。记录手术视频、术后90 d内并发症、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10例患者均顺利完成全腹腔镜下机器人辅助根治性膀胱切除回肠原位新膀胱手术,手术时间(584±56)min,出血量(655±275)ml,术后进食时间1~3 d;1例患者术后6个月行切口疝修复术,其余无Ⅲ级以上并发症。5例(50%)患者术后6~12个月尿流动力学检查提示最大尿流率及平均尿流率分别为(6.3±4.5)ml/s、1.80(0.30)ml/s,术后新膀胱充盈尿量及残余尿量分别为(525±273)ml、161(227)ml,患者日间完全控尿9例(90%),夜间完全控尿8例(80%)。随访期间,发现4侧肾盂轻度扩张,监测分肾功能正常。1例患者术后18个月出现肺转移,其余患者未发现局部复发及转移。结论“紫砂壶型”回肠原位新膀胱是在Studer型、VIP型回肠新膀胱基础上的储尿囊成型技术改进,术后新膀胱功能良好,能有效保护上尿路形态,恢复排尿功能。
Objective To explore the urinary control and oncological prognosis of patients with a modified Robotic intracorporeal orthotopic ileal neobladder.Methods A group of 10 consecutive patients underwent robot-assisted radical cystectomy and orthotopic ileal neobladder surgery from May 2017 to June 2019,including 9 males and 1 female,average age was(63±11)years,5 cases with very high risk non-muscle invasive bladder cancer(NMIBC),5 cases with muscle invasive bladder cancer(MIBC).The postoperative follow-up time was 12-37 months.Record the video of the operation,complications within 90 days after the operation,the patient's urinary control recovery during the follow-up period,renal function,changes in the imaging structure of the upper urinary tract,and oncology prognosis.Results All the 10 patients were completed successfully the robot assisted radical cystectomy and intracorporeal orthotopic ileal neobladder,the operation time was(584±56)min,the blood loss was(655±275)ml,and the postoperative feeding time was 1-3 days;1 patient underwent incisional hernia repair 6 months after operation,and the rest had no grade III or above complications.Some patients underwent urodynamic examination within 6-12 months after surgery,the maximum urine flow rate and average urine flow rate at the last follow-up were(6.3±4.5)ml/s and 1.80(0.30)ml/s,respectively.The postoperative neobladder filling urine volume and residual urine volume were(525±273)ml and 161(227)ml respectively.There were 9 cases(90%)of complete urinary control during the day and 8 cases(80%)of night urinary control.During the follow-up,4 sides of renal pelvis were slightly dilated,and the monitoring sub-renal eGFR was normal.One patient developed lung metastasis 18 months after surgery,while the remaining patients did not find local recurrence or metastasis.Conclusion Our"Teapot type"ileal orthotopic neobladder is a modified intracorporeal orthotopic ileal neobladder on the basis of Student type and VIP type ileal neobladder.The function of new bladder after operation is good,which can effectively protect the structure of upper urinary tract and restore urination function.
作者
田家乐
张古田
张威
邓永明
林廷升
孙逸凡
张成伟
杨荣
张士伟
甘卫东
李笑弓
郭宏骞
Tian Jiale;Zhang Gutian;Zhang Wei;Deng Yongming;Lin Tinsheng;Sun Yifan;Zhang Chengwei;Yang Rong;Zhang Shiwei;Gan Weidong;Li Xiaogong;Guo Hongqian(Department of Urology,Drum Tower Hospital Affiliated to Medical College of Nanjing University,Nanjing 210008,China)
出处
《中华腔镜泌尿外科杂志（电子版）》
2020年第6期420-424,共5页
Chinese Journal of Endourology(Electronic Edition)
基金
国家自然基金项目(11774167)。
