[1]王健阁 朱照伟 范雅峰 张雪培**.机器人膀胱癌根治术治疗75岁及以上膀胱癌[J].中国微创外科杂志,2021,01(1):18-22.
　Wang Jiange,Zhu Zhaowei,Fan Yafeng,et al.Robotassisted Radical Cystectomy for Bladder Cancer in Elderly Patients ≥ 75 Years Old[J].Chinese Journal of Minimally Invasive Surgery,2021,01(1):18-22.
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机器人膀胱癌根治术治疗75岁及以上膀胱癌()
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《中国微创外科杂志》[ISSN:1009-6604/CN:11-4526/R]

卷:
01
期数:
2021年1期
页码:
18-22
栏目:
临床研究
出版日期:
2021-02-26

文章信息/Info

Title:
Robotassisted Radical Cystectomy for Bladder Cancer in Elderly Patients ≥ 75 Years Old
作者:
王健阁 朱照伟 范雅峰 张雪培**
(郑州大学第一附属医院泌尿外科，郑州450052)
Author(s):
Wang Jiange;  Zhu Zhaowei;  Fan Yafeng;  et al.
Department of Urology, First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China
关键词:
机器人; 膀胱癌根治术; 高龄患者
Keywords:
Robot; Radical cystectomy; Elderly patient
文献标志码:
A
摘要:
目的探讨机器人膀胱癌根治术治疗年龄≥75岁膀胱癌的安全性及有效性。方法分析2015年1月~2019年1月我院58例≥75岁膀胱癌行改良整体法机器人膀胱癌根治术的临床资料。建立通道，结扎双侧输尿管，离断膀胱侧韧带，分离打开狄氏筋膜，游离膀胱前壁，离断前列腺韧带、尿道，切除标本，盆腔淋巴结清扫，尿流改道。结果手术时间、术中出血量、术后住院时间分别为(146.1±33.2)min、(186.9±104.4)ml、(9.3±3.1)d。58例术后切缘均为阴性，52例尿路上皮癌，其中4例同时合并前列腺腺癌；4例膀胱鳞癌；2例膀胱小细胞癌。40例病理T分期在T2期及以上，9例伴有淋巴结转移。术后30 d内24例发生并发症，其中20例Clavien分级≤2级，4例Clavien分级≥3级，无死亡；术后30～90 d内9例发生并发症，其中泌尿系感染8例，1例因多器官功能衰竭死亡。58例术后随访2~56个月，平均16个月，18例死亡，其中11例死于肿瘤进展，1例手术相关死亡，6例考虑非肿瘤原因死亡。结论对于年龄≥75岁可耐受根治手术的膀胱癌患者，机器人膀胱癌根治术安全有效。
Abstract:
ObjectiveTo explore the safety and perioperative effect of robotassisted radical cystectomy in patients aged ≥ 75 years old.MethodsWe reviewed the medical records of 58 cases of bladder cancer aged ≥ 75 years old undergoing robotassisted radical cystectomy with modified integral method in our hospital from January 2015 to January 2019. The main operation steps were as follows: establishing a channel, ligating bilateral ureters, breaking the lateral bladder ligament, separating and opening denonvilliers fascia, freeing the anterior wall of the bladder, cutting off the prostate ligament, cutting off the urethra, resecting specimens, and performing pelvic lymph node dissection and urinary diversion.ResultsThe operation time was(146.1±33.2) minutes, the intraoperative blood loss was (186.9±104.4) ml and the time of their staying at hospital after surgery were (9.3±3.1) days. All of the 58 patients had negative surgical margins, 52 (89.7%) patients were urothelial carcinoma with and 4 (6.9%) patients combined with prostate cancer; 4 (6.9%) patients were squamous cell carcinoma; 2 (3.4%) patients were small cell carcinoma of the urinary bladder. The pathological stage was T2 or above in 40 cases, and 9 cases had lymph node metastasis. Complications occurred in 24 cases within 30 days after operation, including 20 cases of Clavien grade ≤ 2, 4 cases of Clavien grade ≥ 3, and no death. Complications occurred in 9 cases within 30-90 days after operation, including 8 cases of urinary tract infection and 1 case of death due to multiple organ failure. Followups ranged from 2 to 56 months (mean, 16 months) in 58 patients. A total of 18 patients died, including 11 patients died of tumor progression, 1 patient died of surgery related death, and 6 patients died of non tumor causes.ConclusionFor bladder cancer patients aged ≥ 75 years old who can tolerate radical cystectomy, robotassisted radical cystectomy is safe and effective.

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备注/Memo

备注/Memo:
基金项目：国家自然科学基金(81702503)**通讯作者，Email:zhangxuepei@263.net
更新日期/Last Update: 2021-04-02