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目的:探讨合并腹部手术史的达芬奇机器人泌尿手术的临床疗效及安全性。方法:回顾性分析12例合并腹部手术史并实施达芬奇机器人辅助腹腔镜手术患者的临床资料,男8例,女4例,年龄48~65岁。患者既往均有腹部手术史,手术方式包括膀胱根治性切除及双侧输尿管皮肤造口术3例,前列腺癌根治术5例,孤立肾肾盂切开取石及成形术4例。结果:手术均获成功,无中转开腹病例及相关脏器损伤发生。膀胱根治性切除及双侧输尿管皮肤造口术平均手术时间(410±30)min,平均出血量(740±100)ml,平均住院时间(17±1)d。前列腺癌根治术平均手术时间(210±20)min,平均出血量(240±100)ml,术后胃肠功能恢复时间5~7d,平均(6±1)d,平均住院时间(11±1)d。右侧孤立肾肾盂切开取石及肾盂成形术平均手术时间(80±20)min,平均出血量(60±15)ml,术后胃肠功能恢复时间3~6d,平均(4±1)d,平均住院时间(7±1)d。结论:达芬奇机器人泌尿系统手术可在某些合并腹部手术史病例安全有效的实施,但需严格挑选病例,远期疗效有待进一步研究。
Objective: To investigate the clinical efficacy and safety of Da Vinci robotic urological surgery combined with abdominal surgery history. Methods: A retrospective analysis of 12 patients with history of abdominal surgery and the implementation of da Vinci robot assisted laparoscopic surgery in patients with clinical data, 8 males and 4 females, aged 48 to 65 years. All patients had a previous history of abdominal surgery. Surgical procedures included radical cystectomy and bilateral ureteral skin ostomy in 3, radical prostatectomy in 5, isolated renal pelvis incision and angioplasty in 4. Results: All the operations were successful. There were no cases of transit laparotomy and related organ injury. The average operative time (410 ± 30) min, mean amount of bleeding (740 ± 100) ml and average hospitalization time (17 ± 1) d in radical cystectomy and bilateral ureterocutaneous ostomy. The average operation time (210 ± 20) min, average blood loss (240 ± 100) ml, postoperative gastrointestinal function recovery time 5-7 days, average (6 ± 1) days, average length of stay (11 ± 1) d. The average operation time (80 ± 20) min, average amount of bleeding (60 ± 15) ml, postoperative recovery time of gastrointestinal function was 3 ~ 6 days, mean (4 ± 1) days , The average hospital stay (7 ± 1) d. Conclusion: Da Vinci robotic urological surgery can be safely and effectively implemented in some cases with history of abdominal surgery. However, it is necessary to select the cases strictly and the long-term therapeutic effect remains to be further studied.