机器人辅助与开放性膀胱切除术加回肠膀胱术治疗神经源性膀胱的比较研究
Robotic versus open cystectomy with ileal conduit for the management of neurogenic bladder: a comparative study.
作者信息
Beirnaert Jeanne, Benarroche Davy, Pinar Ugo, Roupret Morgan, Phé Véronique, Vaessen Christophe, Parra Jerome, Chartier-Kastler Emmanuel, Seisen Thomas
机构信息
APHP, Sorbonne University, GRC 5, Predictive Onco-Urology, Pitié-SalpêtrièreHôpital, Urology, 75013, Paris, France.
Université Libre de Bruxelles, Hôpital Erasme, Service d'Urologie, 1080, Brussels, Belgium.
出版信息
World J Urol. 2022 Dec;40(12):2963-2970. doi: 10.1007/s00345-022-04190-1. Epub 2022 Oct 25.
PURPOSE
Cystectomy associated with non-continent ileal diversion is a common surgery in patients with neurogenic bladder. Few data are available, especially for the robotic approach. Our purpose was to compare open cystectomy (OC) and robot-assisted radical cystectomy (RARC) with ileal conduit, regarding peri- and post-operative outcomes.
METHODS
We included each patient who underwent cystectomy and ileal conduit for neurogenic bladder in a referral-center between January 2017 and November 2021. Data were retrospectively analyzed. Median follow-up was 16.6 months [IQR: 5; 41]. All patients had neurogenic bladder with failure of conservative treatment and/or impacted Quality of Life (QoL). Open cystectomy with non-continent ileal diversion and robot-assisted cystectomy with intra-corporeal non-continent ileal diversion were compared. Primary endpoint was postoperative complications. Secondary endpoints were length of hospital stay (LOS), surgery duration, blood loss and ureteral anastomosis stricture.
RESULTS
A total of 123 patients were included, n = 85 (69.1%) undergoing OC and n = 38 (30.9%) RARC. Significant differences were observed for: operative time (OC 266.9 ± 64 vs. RARC 205.8 ± 55.5 min, p < 0.001), blood loss (OC 737.7 ± 515.8 vs. RARC 245.8 ± 169.6 ml, p < 0.001), delay until feeding resumption (OC 7.1 ± 4.7 vs. RARC 5.5 ± 2.9 days, p = 0.05) and mean LOS (OC 21.6 ± 13.9 vs. RARC 16.2 ± 7.6 days, p = 0.03). In RARC group, there were 10.5% complications Clavien-Dindo > 2 whereas 23.8% complications underwent in the OC group (p = 0.1).
CONCLUSION
RARC is a safe approach for management of neurological bladder showing significantly better perioperative outcomes.
目的
膀胱切除术联合非可控性回肠膀胱术是神经源性膀胱患者的常见手术。目前可用的数据较少，尤其是关于机器人手术方法的数据。我们的目的是比较开放性膀胱切除术（OC）和机器人辅助根治性膀胱切除术（RARC）联合回肠膀胱术的围手术期和术后结果。
方法
我们纳入了2017年1月至2021年11月期间在一家转诊中心接受膀胱切除术和回肠膀胱术治疗神经源性膀胱的每一位患者。对数据进行回顾性分析。中位随访时间为16.6个月[四分位间距：5；41]。所有患者均患有神经源性膀胱，保守治疗失败和/或生活质量（QoL）受到影响。比较开放性膀胱切除术联合非可控性回肠膀胱术和机器人辅助膀胱切除术联合体内非可控性回肠膀胱术。主要终点是术后并发症。次要终点是住院时间（LOS）、手术持续时间、失血量和输尿管吻合口狭窄。
结果
共纳入123例患者，85例（69.1%）接受OC，38例（30.9%）接受RARC。观察到以下显著差异：手术时间（OC 266.9±64 vs. RARC 205.8±55.5分钟，p<0.001）、失血量（OC 737.7±515.8 vs. RARC 245.8±169.6毫升，p<0.001）、恢复进食延迟时间（OC 7.1±4.7 vs. RARC 5.5±2.9天，p=0.05）和平均LOS（OC 21.6±13.9 vs. RARC 16.2±7.6天，p=0.03）。在RARC组中，Clavien-Dindo>2级的并发症发生率为10.5%，而OC组为23.8%（p=0.1）。
结论
RARC是治疗神经源性膀胱的一种安全方法，围手术期结果明显更好。
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