Department of Urology, School of Medicine, Kitasato University, Sagamihara, Japan.
Department of Urology, School of Medicine, Kitasato University, Sagamihara, Japan.
Asian J Surg. 2019 Jan;42(1):189-196. doi: 10.1016/j.asjsur.2017.11.002. Epub 2017 Dec 15.
We compared the perioperative outcomes of patients with bladder cancer according to three different procedures: robot-assisted laparoscopic radical cystectomy (RALC), laparoscopic radical cystectomy (LRC), and open radical cystectomy (ORC).
From April 2008 to March 2017, 36 consecutive patients underwent radical cystectomy and ileal conduit with RALC (n = 10), LRC (n = 10), or ORC (n = 16). All patients underwent RALC and LRC with extracorporeal urinary diversion. Perioperative data were patient demographics, perioperative laboratory data including hematocrit and creatinine, intraoperative crystalloids and colloids, estimated blood loss (EBL), allogeneic transfusion, respiratory parameters including maximum end-tidal carbon dioxide (EtCO) and respiratory rate, arterial blood gas data including highest pH, partial pressure of CO (PaCO), partial pressure of oxygen (PaO), operative time, opiate consumption including intraoperative and postoperative anesthesia, time of hospital stay, time to oral intake and normal diet, and adverse events.
EBL was less for RALC than for other procedures (p = 0.0004). No blood transfusions were performed for RALC, but ORC required significant blood transfusions (p = 0.003). Respiratory rate was highest and PaCO was lowest for RALC. Preoperative creatinine levels were significantly worse for the RALC group, but no significant differences were noted after surgery. There were no significant differences among the groups in regard to hematocrit levels. Operative time, laparoscopic time, intraoperative anesthesia, and postoperative anesthesia did not differ among the groups. High-grade adverse events were only seen for ORC.
Although RALC required a steep Trendelenburg position, which might add elements of risk, RALC was safe even for this small cohort.
我们比较了膀胱癌患者接受三种不同手术方式（机器人辅助腹腔镜根治性膀胱切除术[RALC]、腹腔镜根治性膀胱切除术[LRC]和开放性根治性膀胱切除术[ORC]）的围手术期结果。
2008 年 4 月至 2017 年 3 月，36 例连续患者接受了根治性膀胱切除术和回肠造口术，其中 RALC（n=10）、LRC（n=10）或 ORC（n=16）。所有患者均行 RALC 和 LRC 体外尿流改道术。围手术期数据包括患者人口统计学、围手术期实验室数据（包括血细胞比容和肌酐）、术中晶体和胶体、估计失血量（EBL）、异体输血、呼吸参数（包括最大呼气末二氧化碳[EtCO]和呼吸频率）、动脉血气数据（包括最高 pH 值、二氧化碳分压[PaCO]、氧分压[PaO]）、手术时间、包括术中及术后麻醉的阿片类药物消耗、住院时间、开始口服及正常饮食时间和不良事件。
RALC 的 EBL 明显少于其他术式（p=0.0004）。RALC 未进行输血，但 ORC 需要大量输血（p=0.003）。RALC 的呼吸频率最高，PaCO 最低。RALC 组术前肌酐水平明显较差，但术后无明显差异。各组的血细胞比容水平无显著差异。手术时间、腹腔镜时间、术中麻醉和术后麻醉在各组之间无差异。仅在 ORC 组观察到高级别不良事件。
尽管 RALC 需要采用陡峭的头高脚低位，这可能会增加一些风险因素，但即使对于这一小队列，RALC 也是安全的。
