Sasaki Yutaro, Shiozaki Keito, Nakanishi Ryoichi, Izaki Hirofumi, Kanda Kazuya
Department of Urology, Tokushima Prefectural Central Hospital.
Nihon Hinyokika Gakkai Zasshi. 2019;110(2):80-85. doi: 10.5980/jpnjurol.110.80.
(Objectives) While robot assisted radical cystectomy (RARC) has been associated with improved perioperative outcomes such as blood loss, hospital stay, and improved convalescence, much of the criticism has been attributable to the longer operative time. Opinions are divided regarding whether intracorporeal urinary diversion (ICUD) or extracorporeal urinary diversion (ECUD) should be performed. The aim of this study is to evaluate the utility of RARC and ICUD by comparing with the conventional method. (Patients and methods) From December 2014 to July 2018, 14 patients underwent laparoscopic radical cystectomy (LRC) and 16 patients underwent RARC at our institution. Among the 30 patients, 23 underwent ileal conduit or orthotopic bladder; these patients were divided into two groups: an ICUD patient group (n=10) and an ECUD patient group (n=13). Treatment outcomes were compared between groups. (Results) Compared to patients who underwent LRC those treated with RARC had older (75 vs. 67, P=0.031). There was a trend of high-risk cases (American Society of Anesthesiologists' physical status classification ≥3) more frequently (31.3% vs. 7.1%, P=0.176). Patient treated with RARC had less blood loss (150 vs. 544 ml, P=0.003). There was no significant difference in the intra- and postoperative complication rates (12.5% vs. 21.4%, P=0.642). Compared to patients who underwent ECUD, those treated with ICUD included a longer operative time for urinary diversion (222 vs. 181 minutes, P=0.007) but less maximal incision length without perineal incision (3.0 vs. 6.0 cm, P=0.002). (Conclusions) Our data suggests that RARC is a safe procedure with potential advantages in terms of reduced blood loss. ICUD has longer operative time but is a procedure with excellent cosmetic results.
（目的）虽然机器人辅助根治性膀胱切除术（RARC）与围手术期结果改善相关，如失血减少、住院时间缩短和康复改善，但大部分批评都归因于手术时间较长。关于应进行体内尿流改道（ICUD）还是体外尿流改道（ECUD），意见存在分歧。本研究的目的是通过与传统方法比较来评估RARC和ICUD的效用。（患者和方法）2014年12月至2018年7月，14例患者在我院接受了腹腔镜根治性膀胱切除术（LRC），16例患者接受了RARC。在这30例患者中，23例接受了回肠膀胱术或原位膀胱术；这些患者被分为两组：ICUD患者组（n = 10）和ECUD患者组（n = 13）。比较两组的治疗结果。（结果）与接受LRC的患者相比，接受RARC治疗的患者年龄更大（75岁对67岁，P = 0.031）。高危病例（美国麻醉医师协会身体状况分类≥3）的出现趋势更频繁（31.3%对7.1%，P = 0.176）。接受RARC治疗的患者失血更少（150毫升对544毫升，P = 0.003）。术中及术后并发症发生率无显著差异（12.5%对21.4%，P = 0.642）。与接受ECUD的患者相比，接受ICUD治疗的患者尿流改道手术时间更长（222分钟对181分钟，P = 0.007），但最大切口长度（无会阴切口）更小（3.0厘米对6.0厘米，P = 0.002）。（结论）我们的数据表明，RARC是一种安全的手术，在减少失血方面具有潜在优势。ICUD手术时间较长，但具有出色的美容效果。
