微创泌尿外科杂志

目的:总结早期开展机器人辅助腹腔镜手术在泌尿外科应用的经验,探讨机器人辅助腹腔镜在泌尿外科中应用价值。方法:分析2007年10月~2013年11月行机器人辅助腹腔镜泌尿外科手术500例患者。结果:500例中497例成功完成手术,上尿路手术135例,占27.16%,包括肾上腺癌切除术2例(0.4%)、肾部分切除术60例(12.07%)、肾根治性切除术37例(7.44%)、肾输尿管全长切除术6例(1.21%)、肾囊肿去顶减压术3例(0.6%)、肾盂成形术11例(2.21%)、输尿管膀胱再植术14例(2.82%)、输尿管探查松解术1例(0.2%)、输尿管狭窄段切除及端端吻合1例(0.2%)。下尿路手术362例,占72.84%,包括前列腺癌根治术319例(64.19%)、膀胱根治性切除术及回肠膀胱术24例(4.83%)、原位新膀胱术7例(1.41%)、输尿管皮肤造瘘3例(0.6%)、盆腔肿物切除术3例(0.6%)、精囊肿物切除术4例(0.8%)、膀胱结石碎石术1例(0.2%)、骶骨加固术1例(0.2%)。中转开放手术3例,包括腹膜后纤维化松解术1例、前列腺癌根治术1例、膀胱全切1例,占0.6%。无显著并发症发生。结论:遵循开放手术及普通腹腔镜原则,机器人辅助腹腔镜手术在技术上是安全有效的,可取得满意的临床治疗效果。具有创伤小、术野清晰、失血少及学习曲线短等优点。

Objective:To summarize the experience in the earliest robotic-assisted laparoscopic surgery in urology and discuss its applied value.Methods:500patients underwent robot-assisted laparoscopic urological surgery during 2007October to 2013November.Results:497of 500cases were operated successfully.The upper tract surgery was performed on 135cases,accounting for 27.16%,including 2cases of adrenalectomy(0.4%),60cases of partial nephrectomy(12.07%),37cases of radical nephrectomy(7.44%),6cases of nephroureterectomy(1.21%),3cases of unroofing of cyst of kidney(0.6%),11cases of pyeloplasty(2.21%),14cases of ureterovesical reimplantation(2.82%),1case of ureterolysis(0.2%),and 1case of resecction of ureteral stenosis and ureteral anastomosis(0.2%).The lower urinary surgery was performed on 362cases,accounting for 72.84%,including 319cases of prostatectomy(64.19%),24cases of radical cystectomy and ileal conduit(4.83%),7cases of radical cystectomy and neobladder(1.41%),3cases of ureterocutaneostomy(0.6%),3cases of pelvic neoplasm resection(0.6%),4 cases of excision of seminal vesicle neoplasm(0.8%),1case of lithotripsy of bladder calculus(0.2%),and 1case of sacrocolpopexy(0.2%).Three cases were converted to open surgery(0.6%),including the retroperitoneal fibrosis release in 1case,radical prostatectomy in 1case,and cystectomy in 1case.All the patients recovered without any complication.Conclusions:Following the principles and dissecting anatomical surface of open and laparoscopic surgery,the robotic-assisted laparoscopic surgery is safe and effective technically,and can gain satisfied clinical treatment outcomes,with the many advantages such as with a small trauma,clear operation field,less blood loss and short learning curve.