[1]刘华 贾光 王久亮 张国灵 陶柏居 王渤文 孟乐 祝相煜 季旭然 王春阳**.机器人辅助后腹腔镜改进“一体位”治疗上尿路上皮癌7例报告[J].中国微创外科杂志,2023,01(12):944-949.
　Liu Hua,Jia Guang,Wang Jiuliang,et al.Robotassisted Posterior Laparoscopic Modified “Singleposition” Treatment for Upper Tract Urothelial Carcinoma: Report of 7 Cases[J].Chinese Journal of Minimally Invasive Surgery,2023,01(12):944-949.
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机器人辅助后腹腔镜改进“一体位”治疗上尿路上皮癌7例报告()

《中国微创外科杂志》[ISSN:1009-6604/CN:11-4526/R]

卷:
01
期数:
2023年12期
页码:
944-949
栏目:
技术改进
出版日期:
2023-12-25

文章信息/Info

Title:
Robotassisted Posterior Laparoscopic Modified “Singleposition” Treatment for Upper Tract Urothelial Carcinoma: Report of 7 Cases
作者:
刘华 贾光 王久亮 张国灵 陶柏居 王渤文 孟乐 祝相煜 季旭然 王春阳**
(哈尔滨医科大学附属第一医院泌尿外科，哈尔滨150000)
Author(s):
Liu Hua;  Jia Guang;  Wang Jiuliang;  et al.
Department of Urology, First Affiliated Hospital of Harbin Medical University, Harbin 150000, China
关键词:
机器人辅助手术; 肾输尿管根治性切除术; 单一体位; 后腹腔镜; 吲哚菁绿
Keywords:
Robotassisted surgery; Radical nephroureterectomy; Single position; Posterior laparoscopy; Indocyanine green
文献标志码:
B
摘要:
目的探讨机器人辅助后腹腔镜改进“一体位”肾输尿管根治性切除术的可行性。方法2022年4月～2023年4月我科行机器人辅助后腹腔镜下单一体位肾输尿管根治性切除术7例。患者完全健侧卧位，建立人工气腹，于腋后线右肋缘、腋中线髂嵴上3～4 cm、腋前线肋缘下6～8 cm和腋中线髂嵴上3～4 cm水平线靠近腹直肌外缘处分别置入trocar，先切除肾脏后，向下游离输尿管至髂血管处，再将机器人主关节 180°扭转进行重新对接后，向下游离输尿管至膀胱壁处，夹闭导尿管，膀胱注入吲哚菁绿及蒸馏水混合液后打开膀胱，洗净膀胱内液体，观察对侧输尿管口，袖套状切除患侧输尿管，VLOCK 20 缝合线分两层缝合膀胱切口，腋后线右肋缘下与腋中线髂嵴上3～4 cm连线方向延长切口取出标本。结果7例手术均顺利完成,手术操作时间155～263 min，平均247.0 min；术中出血20～100 ml，平均42.9 ml。术后肛门排气时间为14～24 h，平均22.6 h。1例术后出现吸收热，2例术后中度贫血（1例术后肌间动脉破裂导致大量出血和手术区域血肿形成，出血量约1000 ml，导致失血性贫血；1例术前后均中度贫血），2例术后切口脂肪液化。住院时间为8～16 d，平均11.6 d。7例病理均为高级别尿路上皮癌。7例术后随访3～9个月，平均为6.2月，均无膀胱肿瘤复发或远处转移。结论机器人辅助后腹腔镜改进“一体位”肾输尿管根治性切除术安全、可行。
Abstract:
ObjectiveTo evaluate the feasibitity of robotassisted posterior laparoscopic modified “singleposition” radical nephroureterectomy.MethodsA retrospective analysis was made on 7 patients receiving robotassisted posterior laparoscopic singleposition radical nephroureterectomy between April 2022 and April 2023. The patients were in a fully healthy lateral position, and an artificial pneumoperitoneum was established. Trocars were placed at the right costal margin of the posterior axillary line, 3-4 cm above the iliac crest of the midaxillary line, 6-8 cm below the anterior axillary line, and 3-4 cm above the iliac crest of the midaxillary line near the outer edge of the musculus rectus abdominis, respectively. After the kidney was removed, the ureter was freed down to the iliac vessels, and then the main joint of the robot was reversed 180° for redocking. The ureter was continuously freed downwards to the bladder wall and the catheter was clamped. The bladder was opened after filling with indocyanine green and distilled water mixture. Then the fluid in the bladder was washed, the contralateral ureteral orifice was observed, the affected side of the ureter was resected, and the bladder incision was sutured by two layers with VLOCK 20 sutures. The incision was extended under the right costal margin of the posterior axillary line and 3-4 cm above the iliac crest of the midaxillary line to remove the specimen.ResultsThe operation was successfully completed in all the 7 cases. The surgical operation time was 155-263 min (mean, 247.0 min) and the blood loss was 20-100 ml (mean, 42.9 ml). The postoperative anal exhaust time was 14-24 h (mean, 22.6 h). There were 1 case of postoperative absorption fever, 2 cases of moderate anemia, and 2 cases of postoperative incision fat liquefaction. In the 2 patients with moderate anemia,one patient developed postoperative intramuscular artery rupture leading to massive bleeding and the formation of hematoma in the surgical area, with the amount of bleeding being approximately 1000 ml,and the other had moderate anemia before and after surgery. The hospital stay ranged 8-16 d (mean, 11.6 d). Pathologic examinations showed highgrade uroepithelial carcer in all the patients. Postoperative followups lasted 3-9 months, with a mean of 6.2 months. None had bladder tumor recurrence or distant metastasis. ConclusionRobotassisted posterior laparoscopic modified “singleposition” radical nephroureterectomy is safe and feasible.

参考文献/References:

[1]王希路,胡海龙,吴长利.不同根治手术在肾盂癌治疗中的比较.肿瘤研究与临床,2011,23(3):185-187.
[2]杨诚,梁朝朝.机器人辅助腹腔镜肾输尿管全长切除术的应用进展.中华泌尿外科杂志,2021,42(6):477-480.
[3]崔庆敖,覃茂,张伟阳,等.机器人辅助腹腔镜根治性肾输尿管切除术治疗非转移性高危上尿路尿路上皮癌的疗效分析.重庆医科大学学报,2022,47(4):439-443.
[4]Rouprêt M, Babjuk M, Burger M, et al. European Association of Urology guidelines on upper urinary tract urothelial carcinoma: 2020 update. Eur Urol,2021,79(1):62-79.
[5]徐柳汀,张春雷,王东星,等.新辅助免疫治疗联合化疗后手术治疗局部晚期上尿路尿路上皮癌一例.实用肿瘤杂志,2023,38(5):476-480.
[6]后森林,侯俊清,张建华,等.上尿路尿路上皮癌治疗方式的选择.临床泌尿外科杂志,2021,36(6):496-501.
[7]苗腾飞,王利辉,李云龙,等.经腹腔腹腔镜单一体位肾输尿管全长切除术加膀胱袖套切除术治疗上尿路尿路上皮癌临床疗效分.肿瘤基础与临床,2022,35(3):244-247.
[8]Kim TH，Hong B，Seo HK，et al. The comparison of oncologic outcomes between open and laparoscopic radical nephroureterectomy for the treatment of upper tract urothelial carcinoma：a Korean multicenter collaborative study. Cancer Res Treat,2019,51(1):240-251.
[9]Sung HH, Jeon HG, Han DH, et al. Diagnostic ureterorenoscopy is associated with increased intravesical recurrence following radical nephroureterectomy in upper tract urothelial carcinoma. PLoS One,2015,10(11):e0139976.
[10]Sparwasser P, Epple S, Thomas A, et al. First completely robotassisted retroperitoneal nephroureterectomy with bladder cuff: a stepbystep technique. World J Urol,2022,40(4):1019-1026.
[11]刘锋,毛祖杰,张琦,等.完全腹腔镜肾盂输尿管癌根治术治疗上尿路肿瘤32例报告.中国微创外科杂志,2011,11(11):989-991.
[12]宋帅帅,陈海飞,张峰,等.上尿路上皮癌根治术中膀胱袖状处理的研究进展.国际泌尿系统杂志,2023,43(1):173-175.
[13]Luo F, Wang YS, Su YH, et al. Prognostic implications of preoperative anemia in urothelial carcinoma: A metaanalysis. PLoS One,2017,12(2):e0171701.
[14]Veccia A，Antonelli A，Francavilla S, et al. Robotic versus other nephroureterectomy techniques：a systematic review and metaanalysis of over 87,000 cases. World J Urol,2020,38(4):845-852.
[15]Ludwig WW，Gorin MA，Pierorazio PM，et al. Frontiers in robot assisted retroperitoneal oncological surgery. Nat Rev Urol,2017,14(12):731-741.
[16]李冬梅.剖宫产腹部手术切口脂肪液化60例临床分析.中外医疗,2021,40(11):83-85.
[17]左佳乐,何綦琪,李笑然,等.吲哚菁绿在泌尿外科机器人手术中的应用.临床泌尿外科杂志,2023,38(2):151-156.

备注/Memo

备注/Memo:
基金项目：哈尔滨医科大学附属第一医院杰出青年医学人才培养资助项目（HYD2020JQ0020）**通讯作者，Email：wangchunyang001@hotmail.com
更新日期/Last Update: 2024-04-03