摘要
目的探讨保留前列腺侧包膜的机器人辅助根治性膀胱切除-原位回肠新膀胱术的早期临床疗效。方法回顾性分析2018年12月至2020年11月中山大学孙逸仙纪念医院单一术者完成的19例保留前列腺侧包膜的机器人辅助根治性膀胱切除-原位回肠新膀胱术患者的临床资料。患者平均年龄57.6(37~74)岁;国际勃起功能指数-5(IIEF-5)评分平均20.4(4~25)分。患者为高危非肌层浸润性膀胱癌或cT2N0M0期肌层浸润性膀胱癌;所有患者术前检查未发现膀胱颈或尿道肿瘤;术前MRI检查未提示合并前列腺癌且血清PSA<2.5 ng/ml。在前列腺基底部两侧分别用电剪分离前列腺腺体和前列腺侧包膜至前列腺尖部,在两侧分别保留外科包膜或厚度为1~2 mm的前列腺侧包膜。术后1~2周行膀胱造影评估,如无明显吻合口瘘则拔除尿管。术后随访患者的控尿功能、性功能及肿瘤控制情况。结果19例手术均顺利完成。手术时间平均279.9(225~345)min;术中估计出血量平均88.9(30~200)ml。术后住院时间平均15.8(9~23)d。盆腔淋巴结清扫数量平均23.3(11~42)枚。手术切缘均为阴性,术后病理均未提示合并前列腺癌。拔尿管后2周以及1、3、6个月日间控尿率分别为42.1%(8/19)、63.2%(12/19)、78.9%(15/19)、94.7%(18/19),夜间控尿率分别为36.8%(7/19)、63.2%(12/19)、73.7%(14/19)、89.5%(17/19)。术后3、6个月IIEF-5评分平均值分别为7.2(0~22)、10.1(2~22)分。术后平均随访10.1(5.4~26.1)个月,19例均未出现复发或转移。结论对于严格选择的病例,保留前列腺侧包膜的机器人辅助根治性膀胱切除-原位回肠新膀胱术有助于改善患者术后控尿和性功能,其早期临床疗效良好。但该术式的远期临床疗效和肿瘤控制效果仍有待进一步观察。
Objective To investigate the experience and results of the modified lateral prostate capsule sparing robot-assisted radical cystectomy-orthotopic ileal neobladder(LPCS-RARC-OIN).Methods From December 2018 to November 2020,19 patients received LPCS-RARC-OIN by a single surgeon in Sun Yat-sen Memorial Hospital,Sun Yat-sen University.LPCS-RARC-OIN was performed on male patients with high-risk non-muscle-invasive bladder cancer or muscle-invasive bladder cancer cT2N0M0 without tumour in the bladder neck or urethra,and prostate cancer was ruled out by MRI and serum PSA<2.5ng/ml.The average age was 57.6 years,the average IIEF-5 score was 20.4.Separating the prostatic adenoma and the lateral prostate capsule from the base to the apex of the prostate,and retaining the lateral prostate surgical capsule or lateral prostate capsule about 1-2mm thickness.Patients were followed up and urinary function,sexual function and oncological outcomes were recorded.Results All 19 operations were finished successfully.The average operation time was 279.9(225-345)min and average estimated blood loss was 88.9(30-200)ml.The average postoperative hospital stays was 15.8(9-23)days.The average lymph node yields was 23.3(11-42).All surgical margins were negative and no incidental prostate cancer was found.2 weeks,1 month,3 months and 6 months after catheter removal,the daytime and nighttime continence were 42.1%(8/19)and 36.8%(7/19),63.2%(12/19)and 63.2%(12/19),78.9%(15/19)and 73.7%(14/19),94.7%(18/19)and 89.5%(17/19),respectively.3 months and 6 months after operation,the average IIEF-5 score was 7.2 and 10.1 points respectively.The average follow-up was 10.6 months(5.4-26.1 months)and no recurrence or distant metastasis was found in this study.Conclusions LPCS-RARC-OIN could improve the urinary and sexual function in selected patients.However,the long-term follow up is needed for functional and oncological outcomes.
作者
林天歆
李记标
何旺
刘皓
许可慰
董文
黄海
谢文练
黄健
Lin Tianxin;Li Jibiao;He Wang;Liu Hao;Xu Kewei;Dong Wen;Huang Hai;Xie Wenlian;Huang Jian(Department of Urology,Sun Yat-sen Memorial Hospital,Sun Yat-sen University,Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation,Guangdong Clinical Research Center for Urological Diseases,Guangzhou 510120,China)
出处
《中华泌尿外科杂志》
CAS
CSCD
北大核心
2021年第7期491-496,共6页
Chinese Journal of Urology
关键词
膀胱肿瘤
原位回肠新膀胱术
机器人辅助技术
前列腺包膜
功能学结果
Urinary bladder neoplasms
Orthotopic ileal neobladder
Robot-assisted surgery
Prostate capsule
Functional outcomes
