[1]高旭 李耀明 王海峰 王辉清 鲁欣 王燕 方梓宇 盛夏 孙颖浩.机器人辅助的腹腔镜下前列腺癌根治术中三种膀胱颈 -尿道吻合法的比较[J].中华腔镜泌尿外科杂志(电子版),2014,(03):162-166.
 Gao Xu,Li Yaoming,Wang Haifeng,et al.Comparison of the efficiency of three kinds of methods for urethrovesical anastomosis during robotic assisted laparoscopic prostatectomy[J].,2014,(03):162-166.
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机器人辅助的腹腔镜下前列腺癌根治术中三种膀胱颈 -尿道吻合法的比较()
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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:
期数:
2014年03期
页码:
162-166
栏目:
临床研究
出版日期:
2014-06-30

文章信息/Info

Title:
Comparison of the efficiency of three kinds of methods for urethrovesical anastomosis during robotic assisted laparoscopic prostatectomy
作者:
高旭 李耀明 王海峰 王辉清 鲁欣 王燕 方梓宇 盛夏 孙颖浩
200433上海,第二军医大学附属长海医院泌尿外科
Author(s):
Gao Xu Li Yaoming Wang Haifeng Wang Huiqing LU Xin Wang Yan Fang Ziyu Sheng Xia Sun Yinghao.
Department of Urology, Changhai Hospital, Second Military Medical University, Shanghai 200433, China
关键词:
前列腺肿瘤机器人前列腺癌根治术膀胱尿道吻合缝线
摘要:
目的 在开展机器人辅助的腹腔镜下前列腺癌根治术( RALP)初期,尝试不同的膀胱颈 -尿道吻合方法,以期规范化、模式化 RALP术式,并缩短本术式的学习曲线。方法 2012年 4月至 2013年 8月,由单一术者实施机器人辅助的腹腔镜下前列腺癌根治术 40例。40例 RALP术均经腹腔途径实施,术中膀胱颈 -尿道吻合步骤分别应用以下三种方法:(1)自钟面 3点或 9点位进针,单针连续缝合( A组,n=17);(2)自钟面 5点至 7点进针,自制双针连续缝合( B组,n=5);(3)自钟面 5点和 7点进针,Quill免打结倒刺缝线连续缝合( C组,n=18)。分别比较三组的吻合时间、引流管留置时间及术后吻合口相关并发症发生情况等指标;并由术者和第一助手分别主观评估三种技术的难度。结果 40例 RALP手术均获成功,无一例中转开放手术。膀胱颈 -尿道吻合的中位时间在各组间分别为:A组 18 min(14~42 min),B组 17 min(13~35 min),C组 12 min(10~25 min),C组较 A、B组有效地减少了吻合时间( P <0.05),而在吻合相关并发症发生率上三组差异无统计学意义。经由术者主观评估,三种技术难度由 A、C、B依次递减,经由第一助手评估,三种术式的配合技术中单针吻合即 A组难度最大, B组其次, C组最易掌握。结论 在机器人辅助的腹腔镜下前列腺癌根治术中,不同的吻合技术对获得吻合口的密闭性的效果相当,单针吻合可获得更为平整的吻合口后壁,双针吻合法难度较小且更易对抗吻合断端张力,Quill倒刺缝线操作配合最为简便且能有效缩短吻合时间。

参考文献/References:

[1] Schroder FH, Carter HB, Wolters T, et al. Early detection of prostate cancer in 2007. part 1: PSA and PSA kinetics [J]. Eur Urol, 2008, 53(3): 468-477.
[2] The New York Times. Results unproven, robotic surgery wins converts [Internet] New York: The New York Times Co.; c2010. [cited 2012 Oct 17]. Available from: http://www.nytimes. com/2010/02/14/health/14robot.html?pagewanted=1&hp.
[3] Piechaud P. State of the art: Urologic surgery [J]. J Visc Surg, 2011, 148(5): e27-e29.
[4] Branco AW, Kondo W, De Camargo AH, et al. Laparoscopic running urethrovesical anastomosis with posterior fixation [J]. Urology, 2007, 70(4): 799-802.
[5] Gill IS, Zippe CD. Laparoscopic radical prostatectomy: technique[J]. Urol Clin of North Am, 2001, 28(2): 423-436.
[6] 沈周俊 ,王先进 ,何威 ,等.达芬奇机器人辅助腹腔镜前列腺癌根治术的手术要点 (附光盘 ).现代泌尿外科杂志, 2013, 18(2): 108-112.
[7] Williams SB, Alemozaffar M, Lei Y, et al. Randomized controlled trial of barbed polyglyconate versus polyglactin suture for robot-assisted laparoscopic prostatectomy anastomosis: technique and outcomes[J]. Eur Urol, 2010, 58(6): 875-881.
[8] Menon M, Hemal AK, Tewari A, et al. The technique of apical dissection of the prostate and urethrovesical anastomosis in robotic radical prostatectomy[J]. BJU Int, 2004, 93(6): 715-719.
[9] Teber D, Dekel Y, Frede T, et al. The heilbronn laparoscopic training program for laparoscopic suturing: concept and validation [J]. J Endourol, 2005, 19(2): 230-238.
[10] 罗文彬 ,杨波 ,徐斌 ,等.泌尿外科高难度腹腔镜手术关键操作步骤强化训练模型的制备及应用 [J].第二军医大学学报, 2010, 31(1): 101-103.
[11] Vallancien G, Cathelineau X, Baumert H, et al. Complications of transperitoneal laparoscopic surgery in urology: review of 1,311 procedures at a single center[J]. J Urol, 2002, 168(1): 23-26.
[12] Lane T. Assessment of complication and functional outcome reporting in the minimally invasive prostatectomy literature from 2006 to the present[J]. BJUI, 2012, 109(1): 30-30.
[13] Borboroglu PG, Sands JP, Roberts JL, et al. Risk factors for vesicourethral anastomotic stricture after radical prostatectomy[J]. Urology, 2000, 56(1): 96-100.
[14] Altinova S, Serefoglu EC, Ozdemir AT, et al. Factors affecting urethral stricture development after radical retropubic prostatectomy[J]. Int Urol Nephrol, 2009, 41(4): 881-884.
[15] Yildirim A, Basok EK, Ilhan AI, et al. The impact of urinary drainage on the development of anastomotic stricture after radical retropubic prostatectomy [J]. Int Urol Nephrol, 2008, 40 (3): 667-673.
[16] Bartlett LC. Pressure necrosis is the primary cause of wound dehiscence[J]. Can J Surg., 1985, 28(1): 27-30.
[17] Einarsson JI, Vellinga TT, Twijnstra AR, et al. Bidirectional barbed suture: an evaluation of safety and clinical outcomes [J]. JSLS, 2010, 14(3): 381-385.
[18] Greenberg JA, Clark RM. Advances in suture material for obstetric and gynecologic surgery [J]. Rev Obstet Gynecol, 2009, 2 (3): 146-158.
[19] Rashid RM, Rashid R, Sartori M, et al. Breaking strength of barbed polypropylene sutures: rater-blinded, controlled comparison with nonbarbed sutures of various calibers [J]. Arch Dermatol, 2007, 143(7): 869-872.

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备注/Memo

备注/Memo:
基金项目:国家重点基础研究发展计划项目子课题( 2012CB518302)
通讯作者:孙颖浩,Email: sunyh@medmail.com.cn注:高旭和李耀明为共同第一作者
更新日期/Last Update: 2014-06-25