[1]何威 徐兆平 谢欣 祝宇 沈周俊.机器人根治性膀胱切除术加双U 原位膀胱术治疗肌层浸润性膀胱癌[J].中华腔镜泌尿外科杂志(电子版),2016,10(06):383-387.[doi:10.3877/cma.j.issn.1674-3253.2016.06.004 ]
　He Wei,Xu Zhaoping,Xie Xin,et al.Clinical analysis of robotic assisted laparoscopic radical cystectomy and extracorporeal double-U shaped orthotopic neobladder with a modified urethral reconstruction for the treatment of muscle invasive bladder cancer[J].,2016,10(06):383-387.[doi:10.3877/cma.j.issn.1674-3253.2016.06.004 ]
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机器人根治性膀胱切除术加双U 原位膀胱术治疗肌层浸润性膀胱癌()
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中华腔镜泌尿外科杂志(电子版)[ISSN:1006-6977/CN:61-1281/TN]

卷:
10
期数:
2016年06期
页码:
383-387
栏目:
临床研究
出版日期:
2016-12-31

文章信息/Info

Title:
Clinical analysis of robotic assisted laparoscopic radical cystectomy and extracorporeal double-U shaped orthotopic neobladder with a modified urethral reconstruction for the treatment of muscle invasive bladder cancer
作者:
何威 1徐兆平 1谢欣 1祝宇 1沈周俊 2
200025，上海交通大学医学院附属瑞金医院泌尿外科1；200040上海，复旦大学附属华山医院泌尿外科 2
Author(s):
He Wei1;  Xu Zhaoping1;  Xie Xin1;  Zhu Yu1;  Shen Zhoujun2.
Department of Urology, Ruijin Hospital, Shanghai Jiaotong University, School of Medicine, Shanghai 200025, China; 2Department of Urology, Huashan Hospital, Fudan University, Shanghai 200040, China
关键词:
肿瘤; 机器人; 膀胱切除术; 尿流改道
DOI:
10.3877/cma.j.issn.1674-3253.2016.06.004
摘要:
目的探讨对于肌层浸润性膀胱癌患者，以机器人辅助腹腔镜行根治性膀胱切除术的可行性与安全性，同时介绍一种改良的双 U原位新膀胱的尿道重建方法。方法 2010年 3月至 2016年 2月，上海交通大学医学院附属瑞金医院泌尿外科对 8例经过挑选的肌层浸润性膀胱癌患者行达芬奇机器人辅助腹腔镜下根治性膀胱切除术。8例患者均为男性，年龄 51~66岁，术前通过尿道膀胱肿瘤电切术（ TURBT）证实肌层浸润性尿路上皮癌。病理诊断明确后，于经 TURBT术后 4周内手术。膀胱切除后，在机器人辅助腹腔镜下对尿道残端进行 4针预缝，其后通过耻骨上 5 cm小切口取出标本，切取末段回肠以双 U法成形为新膀胱，颈部与预缝的尿道吻合形成原位新膀胱。结果手术均顺利完成，手术时间 300~420 min，失血量 800~1200 ml，输血量 600~1000 ml。术后 1例出现尿漏，在充分引流、加强营养后恢复。术后住院时间 12~21 d，术后均予 GC方案（吉西他滨 800 mg/m2，顺铂 70 mg/m2）进行辅助化疗。随访 4~60个月，1例于术后 2年死于远处转移，另 7例术后复查 CTU无上尿路积水，日间控尿满意，夜间存在尿失禁。结论对于仔细选择过的患者，机器人辅助腹腔镜下根治性膀胱切除术是一种安全可行的术式。术中在机器人视野中预先缝合尿道，行体外尿流改道仅需较小切口，又缩短了手术时间，在技术上无法达到体内尿流改道的情况下，是一种值得推荐的选择。

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备注/Memo

备注/Memo:
基金项目：上海市卫计委面上项目（ 201540081）
通讯作者：沈周俊，Email：shenzhoujun6@163.com
更新日期/Last Update: 2016-12-30