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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(37~64)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T_3N_0M_0。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(360~780)min;平均出血量555(300~1200)ml;平均淋巴结清扫数目为13(4~23)枚。术后2~3 d下地活动,3~4d肠功能恢复,术后平均住院时间20(10~32)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(1~41)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 technical experience and efficacy of da Vinci S robotic system for complete robotic-assisted laparoscopic radical cystectomy (tRARC) plus primary ileocecal neoplasm. Methods: Nine patients with bladder urothelial carcinoma who underwent adjuvant laparoscopic radical cystectomy combined with ileal neo-bladder surgery from March 2012 to July 2015 were retrospectively analyzed. All men, with an average age of 54 (37 ~ 64) years old. Preoperative tumor biopsy diagnosis of invasive or high-grade bladder urothelial carcinoma, preoperative examination showed no other adjacent organ infiltration, pelvic lymph node metastasis or distant metastasis, clinical stage were lower than the T_3N_0M_0.9 patients For general anesthesia tRARCC plus intra-anterior ileal neobladder surgery. Results: Nine patients were successful in surgery. The average operation time was 520 (360 ~ 780) min. The average amount of bleeding was 555 (300 ~ 1200) ml. The mean number of lymph nodes dissection was 13 (4 ~ 23). After 2 ~ 3 days under the ground activity, 3 ~ 4d intestinal function recovery, average postoperative hospital stay 20 (10 ~ 32) d. One month after operation, patients underwent cystography to confirm that there was no anastomotic leakage and the catheter and bilateral ureteral stent were removed. The mean duration of follow-up was 28 (range 1 ~ 41) months. Renal function was normal in all cases, with satisfactory urine control and no hydronephrosis. Conclusion: Based on the initial surgical procedures and follow-up results, tRARC plus neobladder in situ is clinically feasible. More operational experience, standardized surgical procedures and long-term and randomized controlled studies will help to evaluate and promote this technology.