Zhao Q X, Yang F Y, Chen D, Wu L Y, Wang M S, Li X S, Wu S, Shi B K, Xing N Z
Department of Urology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China.
Department of Urology, Beijing Chao-yang Hospital, Capital Medical University, Beijing 100020, China.
Zhonghua Yi Xue Za Zhi. 2020 Jun 23;100(24):1872-1876. doi: 10.3760/cma.j.cn112137-20190925-02112.
To explore the application of Endo-GIA stapler in laparoscopic radical cystectomy, especially in the treatment of lateral bladder ligament, and to evaluate its clinical feasibility and practicability. A retrospective analysis of clinical data about 38 cases of laparoscopic radical cystectomy (LRC) treated in the Department of Urology, Chaoyang Hospital of Beijing and Cancer Hospital, Chinese Academy of Medical Sciences from July 2017 to June 2019 were conducted. The patients were divided into Endo-GIA stopler group(18 cases) and non-Endo-GIA stopler group (20 cases) according to whether Endo-GIA stapler were used. The basic clinical data, operation time of bladder lateral ligament, operation time of bladder lateral wall, operation time of bladder resection, amount of bleeding during operation, pathological data after operation and related indicators of recovery after operation were compared between the two groups. All 38 patients underwent radical cystectomy (RC) successfully under 3-D laparoscopy without conversion to open surgery. The operation time of bladder lateral ligament in Endo-GIA stapler group was significantly shorter than that in non-Endo-GIA stapler group [(3.25±0.75) min vs (9.20±2.95) min, 0.042]; the operation time of bladder lateral wall in Endo-GIA stapler group was significantly shorter than that in non-Endo-GIA stapler group [(8.06±1.66) min vs (14.30±3.37) min, 0.016]. The operation time of cystectomy in the Endo-GIA stapler group was significantly shorter than that in the non-Endo-GIA stapler group [(47.06±4.70) min vs (61.60±14.91) min,0.003]. The amount of bleeding in the Endo-GIA stapler group was significantly shorter than that in the non-Endo-GIA stapler group [(37.77±21.30) ml vs (114.50±39.80) ml, 0.015]. The time of drainage tube removal in Endo-GIA group was significantly shorter than that in the non-Endo-GIA group [(5.83±1.54) d vs (7.30±3.00) d, 0.002]. The length of post-hospitalization in Endo-GIA group was significantly shorter than that in the non-Endo-GIA group [(7.67±1.78) d vs (9.60±3.25) d,0.036]. However, there was no significant difference in other basic clinical data, post-operative pathology and post-operative recovery related indicators. Laparoscopic radical cystectomy using Endo-GIA stapler device is safe and feasible. It is easy to operate, shorten the operation time significantly, and reduce the amount of bleeding. To a certain extent, it is conducive to the recovery of patients after operation to some extent, and worthy of clinical application.
探讨Endo - GIA吻合器在腹腔镜根治性膀胱切除术中的应用,尤其是在膀胱侧韧带处理中的应用,并评估其临床可行性及实用性。对2017年7月至2019年6月在北京朝阳医院泌尿外科及中国医学科学院肿瘤医院接受治疗的38例腹腔镜根治性膀胱切除术(LRC)患者的临床资料进行回顾性分析。根据是否使用Endo - GIA吻合器将患者分为Endo - GIA吻合器组(18例)和非Endo - GIA吻合器组(20例)。比较两组患者的基本临床资料、膀胱侧韧带手术时间、膀胱侧壁手术时间、膀胱切除手术时间、术中出血量、术后病理资料及术后恢复相关指标。38例患者均在三维腹腔镜下成功完成根治性膀胱切除术(RC),无一例中转开放手术。Endo - GIA吻合器组膀胱侧韧带手术时间显著短于非Endo - GIA吻合器组[(3.25±0.75)分钟 vs (9.20±2.95)分钟,P = 0.042];Endo - GIA吻合器组膀胱侧壁手术时间显著短于非Endo - GIA吻合器组[(8.06±1.66)分钟 vs (14.30±3.37)分钟,P = 0.016]。Endo - GIA吻合器组膀胱切除手术时间显著短于非Endo - GIA吻合器组[(47.06±4.70)分钟 vs (61.60±14.91)分钟,P = 0.003]。Endo - GIA吻合器组术中出血量显著少于非Endo - GIA吻合器组[(37.77±21.30)毫升 vs (114.50±39.80)毫升,P = 0.015]。Endo - GIA组引流管拔除时间显著短于非Endo - GIA组[(5.83±1.54)天 vs (7.30±3.00)天,P = 0.002]。Endo - GIA组住院时间显著短于非Endo - GIA组[(7.67±1.78)天 vs (9.60±3.25)天,P = 0.036]。然而,其他基本临床资料、术后病理及术后恢复相关指标差异无统计学意义。使用Endo - GIA吻合器进行腹腔镜根治性膀胱切除术安全可行。操作简便,能显著缩短手术时间,减少术中出血量。在一定程度上有利于患者术后恢复,值得临床应用。