机器人辅助改良 Y 型原位新膀胱术的疗效和安全性

Efficacy and safety of robot-assisted modified Y-shaped ileal orthotopic neobladder reconstruction

摘要

目的 探讨本中心改良术式机器人辅助改良 Y 型原位新膀胱术的疗效和安全性，为探索手术技巧和提高膀胱癌手术治疗水平提供参考。方法 回顾性分析 2020 年 2 月-2022 年 8 月在东南大学附属中大医院泌尿外科接受机器人辅助腹腔镜下根治性膀胱切除术、淋巴结清扫和改良 Y 型回肠原位新膀胱术的 44 例患者的临床资料，对手术体位、Trocar 位置、关键手术步骤、患者围手术期情况、术后并发症、术后 1 年的新膀胱体积、最大尿流率、残余尿量、肾功能和随访期间的尿控功能进行报告与分析。结果 44 例患者手术均顺利完成，手术时间（314.32±51.02）min，改良 Y 型回肠原位新膀胱术时间（103.52±9.56）min，术中出血量（128.18±57.27）mL；术后恢复液体摄入时间（4.16±0.86）d，术后（14.02±3.20）d 拔出输尿管支架和导尿管，拔出导尿管后 1～2 d 出院。15 例患者发生 Clavien-Dindo Ⅱ级并发症，2 例患者发生Ⅲ级并发症。患者平均随访时间（20.77±5.90）个月，随访期间发现 1 例患者排尿困难、2 例泌尿道结石、2 例不完全肠梗阻。术后新膀胱容量（195.75±15.51）mL，最大尿流率（20.30±2.05）mL/s，残余尿量（19.86±13.80）mL，血清肌酐（81.98±25.97）μmol/L。术后 3 个月患者日间和夜间尿失禁的发生率分别为 20.45%和 29.55%，术后 6 个月分别是 11.36%和 18.18%，术后 12 个月分别为 4.55%和 9.09%。结论 机器人辅助改良 Y 型回肠原位新膀胱术具有良好的疗效及安全性，术后并发症发生率较低，可进一步在临床应用。

Abstract

Objective To investigate the efficacy and safety of robot-assisted modified Y-shaped ileal orthotopic neobladder reconstruction, so as to provide reference for clinical practice. Methods The clinical data of 44 patients who underwent robot-assisted laparoscopic radical cystectomy, lymph node dissection, and modified Y-shaped ileal orthotopic neobladder reconstruction during Feb. 2020 and Aug. 2022 were retrospectively analyzed. The surgical position, Trocar position, and key surgical steps were reported. The perioperative conditions, postoperative complications, neobladder volume, maximum urinary flow rate, postvoid residual, renal function, and urinary control function were recorded. Results All 44 surgeries were successfully completed, with operation time of (314.32 ± 51.02) min, modified Y-shaped ileal orthotopic neobladder reconstruction time of (103.52 ± 9.56) min, and bleeding volume of (128.18 ± 57.27) mL. The postoperative time for fluid intake was (4.16 ± 0.86) days, catheter indwelling time was (14.02 ± 3.20) days, and patients were discharged 1 to 2 days after catheter removal. Clavien-Dindo grade Ⅱ and Ⅲ complications occurred in 15 and 2 patients, respectively. During the follow-up of (20.77 ± 5.90) months, dysuria occurred in 1 case, urethral calculi in 2 cases, and incomplete bowel obstruction in 2 cases. The postoperative neobladder capacity was (195.75 ± 15.51) mL, maximal urinary flow rate (20.30 ± 2.05) mL/s, postvoid residual (19.86 ± 13.80) mL and serum creatinine (81.98 ± 25.97) μmol/L. The incidence of daytime and nocturnal urinary incontinence 3, 6 and 12 months after operation were 20.45% and 29.55%, 11.36% and 18.18%, and 4.55% and 9.09%, respectively. Conclusion Robot-assisted modified Y-shaped ileal orthotopic neobladder reconstruction has favorable efficacy and safety, and low incidence of postoperative complications, which can be applied in clinical practice.

关键词

膀胱癌 / 机器人辅助腹腔镜 / 根治性膀胱切除术 / 改良 Y 型回肠原位新膀胱术 / 尿流改道

Key words

bladder cancer / robot-assisted laparoscopy / radical cystectomy / modified Y-shaped ileal orthotopic neobladder / urinary diversion

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