機器人輔助改良Y型原位新膀胱術的療效和安全性

Efficacy and safety of robot-assisted modified Y-shaped ileal orthotopic neobladder reconstruction

ZHAO Tonglei^1，2，MAO Weipu²，WANG Yiduo²，XU Bin^2，3，CHEN Shuqiu²，ZHU Weidong²，CHEN Ming^{2，3，4}，WU Jianping^2，4

（1.Southeast University School of Medicine，Nanjing 210003; 2.Department of Urology，Affiliated Zhongda Hospital of Southeast University，Nanjing 210009; 3.Surgical Research Center，Institute of Urology，Southeast University Medical School，Nanjing 210018; 4.Department of Urology，Nanjing Lishui District Peoples Hospital，Zhongda Hospital Lishui Branch，Southeast University，Nanjing 211299，China）

ABSTRACT：Objective To investigate the efficacy and safety of robot-assisted modified Y-shaped ileal orthotopic neobladder reconstruction，so as to provide reference for clinical practice.Methods The clinical data of 44 patients who underwent robot-assisted laparoscopic radical cystectomy，lymph node dissection，and modified Y-shaped ileal orthotopic neobladder reconstruction during Feb.2020 and Aug.2022 were retrospectively analyzed.The surgical position，Trocar position，and key surgical steps were reported.The perioperative conditions，postoperative complications，neobladder volume，maximum urinary flow rate，postvoid residual，renal function，and urinary control function were recorded.Results All 44 surgeries were successfully completed，with operation time of （314.32±51.02） min，modified Y-shaped ileal orthotopic neobladder reconstruction time of （103.52±9.56） min，and bleeding volume of （128.18±57.27） mL.The postoperative time for fluid intake was （4.16±0.86） days，catheter indwelling time was （14.02±3.20） days，and patients were discharged 1 to 2 days after catheter removal.Clavien-Dindo grade Ⅱ and Ⅲ complications occurred in 15 and 2 patients，respectively.During the follow-up of （20.77±5.90） months，dysuria occurred in 1 case，urethral calculi in 2 cases，and incomplete bowel obstruction in 2 cases. The postoperative neobladder capacity was （195.75±15.51） mL，maximal urinary flow rate （20.30±2.05） mL/s，postvoid residual （19.86±13.80） mL and serum creatinine （81.98±25.97） μmol/L.The incidence of daytime and nocturnal urinary incontinence 3，6 and 12 months after operation were 20.45% and 29.55%，11.36% and 18.18%，and 4.55% and 9.09%，respectively.Conclusion Robot-assisted modified Y-shaped ileal orthotopic neobladder reconstruction has favorable efficacy and safety，and low incidence of postoperative complications，which can be applied in clinical practice.

KEY WORDS：bladder cancer; robot-assisted laparoscopy; radical cystectomy; modified Y-shaped ileal orthotopic neobladder; urinary diversion

摘要：目的 探討本中心改良術式機器人輔助改良Y型原位新膀胱術的療效和安全性，為探索手術技巧和提高膀胱癌手術治療水平提供參考。方法 回顧性分析2020年2月—2022年8月在東南大學附屬中大醫院泌尿外科接受機器人輔助腹腔鏡下根治性膀胱切除術、淋巴結清掃和改良Y型回腸原位新膀胱術的44例患者的臨床資料，對手術體位、Trocar位置、關鍵手術步驟、患者圍手術期情況、術后并發癥、術后1年的新膀胱體積、最大尿流率、殘余尿量、腎功能和隨訪期間的尿控功能進行報告與分析。結果 44例患者手術均順利完成，手術時間（314.32±51.02）min，改良Y型回腸原位新膀胱術時間（103.52±9.56）min，術中出血量（128.18±57.27）mL；術后恢復液體攝入時間（4.16±0.86）d，術后（14.02±3.20）d拔出輸尿管支架和導尿管，拔出導尿管后1～2 d出院。15例患者發生Clavien-Dindo Ⅱ級并發癥，2例患者發生Ⅲ級并發癥。患者平均隨訪時間（20.77±5.90）個月，隨訪期間發現1例患者排尿困難、2例泌尿道結石、2例不完全腸梗阻。術后新膀胱容量（195.75±15.51）mL，最大尿流率（20.30±2.05）mL/s，殘余尿量（19.86±13.80）mL，血清肌酐（81.98±25.97）μmol/L。術后3個月患者日間和夜間尿失禁的發生率分別為20.45%和29.55%，術后6個月分別是11.36%和18.18%，術后12個月分別為4.55%和9.09%。結論 機器人輔助改良Y型回腸原位新膀胱術具有良好的療效及安全性，術后并發癥發生率較低，可進一步在臨床應用。

關鍵詞：膀胱癌；機器人輔助腹腔鏡；根治性膀胱切除術；改良Y型回腸原位新膀胱術；尿流改道

中圖分類號：R737.14 文獻標志碼：ADOI：10.3969/j.issn.1009-8291.2025.02.009

根據2020年全球癌癥統計數據，膀胱癌是第12大最常見癌癥，是泌尿生殖系統第2大常見的惡性腫瘤^［1-2］?！?br>