Haudebert Camille, Hascoet Juliette, Freton Lucas, Khene Zine-Eddine, Dosin Gilles, Voiry Caroline, Samson Emmanuelle, Richard Claire, Neau Anne-Cécile, Drouet Anais, Mathieu Romain, Bensalah Karim, Verhoest Grégory, Manunta Andréa, Peyronnet Benoit
Department of Urology, University of Rennes, Rennes, France.
Department of Physical Medicine and Rehabilitation, University of Rennes, Rennes, France.
Neurourol Urodyn. 2022 Feb;41(2):601-608. doi: 10.1002/nau.24855. Epub 2021 Dec 28.
The objective of the present study was to compare the outcomes of open versus laparoscopic versus robotic cystectomy and ileal conduit for neurogenic lower urinary tract dysfunction (NLUTD).
The charts of all patients who underwent cystectomy and ileal conduit for NLUTD between January 2004 and November 2020 in an academic center were retrospectively reviewed. The approach was either open, laparoscopic or robot-assisted depending on the period (i.e., three consecutive era). For the robotic approach, the diversion was done either intracorporeally or extracorporeally. We compared the perioperative and late postoperative outcomes between the three groups.
After exclusion of 10 patients with non-neurogenic benign conditions, 126 patients were included over the study period. The most frequent neurological conditions were multiple sclerosis (36.5%) and spinal cord injury (25.4%). The approach was open, laparoscopic or robot-assisted in 31 (24.6%), 26 (20.6%) and 69 (54.7%) cases respectively. Seventy-two patients experienced a 90-day postoperative complication (57.1%) of which 22 had a major complication (Clavien 3 or higher, 17.5%) including one death (0.8%). The rate of major postoperative complications was significantly lower in the robotic group (23% vs. 23% vs. 10%; p = 0.049) while the rate of overall complications was comparable across the three groups (58.1% vs. 53.9% vs. 60.6%; p = 0.84). After a median follow-up of 23 months, 22 patients presented a late complication (17.6%), mainly incisional hernia (5; 4%) and uretero-ileal stricture (9; 7.2%). The rate of late complications did not differ significantly between the three approaches.
Cystectomy and ileal conduit for neurogenic bladder is associated with a relatively high perioperative morbidity. The robot-assisted approach may decrease the risk of major postoperative complications.
本研究的目的是比较开放性、腹腔镜与机器人辅助膀胱切除术及回肠代膀胱术治疗神经源性下尿路功能障碍（NLUTD）的疗效。
回顾性分析2004年1月至2020年11月在某学术中心因NLUTD接受膀胱切除术及回肠代膀胱术的所有患者的病历。根据时间段（即三个连续时期），手术方式分别为开放性、腹腔镜或机器人辅助。对于机器人辅助手术，改道可在体内或体外进行。我们比较了三组患者的围手术期和术后远期疗效。
排除10例非神经源性良性疾病患者后，研究期间共纳入126例患者。最常见的神经疾病是多发性硬化（36.5%）和脊髓损伤（25.4%）。手术方式为开放性、腹腔镜或机器人辅助的分别有31例（24.6%）、26例（20.6%）和69例（54.7%）。72例患者术后90天出现并发症（57.1%），其中22例出现严重并发症（Clavien 3级或更高，17.5%），包括1例死亡（0.8%）。机器人辅助组术后严重并发症发生率显著较低（23%对23%对10%；p = 0.049），而三组总体并发症发生率相当（58.1%对53.9%对60.6%；p = 0.84）。中位随访23个月后，22例患者出现远期并发症（17.6%），主要为切口疝（5例；4%）和输尿管回肠狭窄（9例；7.
