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目的探讨da-Vinci机器人辅助腹腔镜下行根治性膀胱前列腺切除术的可行性和疗效。方法患者男性,64岁,膀胱镜检膀胱内多发性占位,CT检查无远处转移。手术采用3臂2辅助孔,da-Vinci机器人辅助腹腔镜下全膀胱切除+前列腺切除,盆腔淋巴结清扫,体外开放手术下取出切除的膀胱、前列腺,原位双U形回肠代膀胱术。观察手术时间、术中失血量、术后肠道功能恢复、术后并发症及手术效果。结果手术时间330min(包括体位摆放及da-Vinci机器人到位30min),其中全膀胱切除180min,原位膀胱术120min。手术失血量800ml,输红细胞600ml,血浆300ml。术后病理:膀胱尿路上皮癌。术后第10天拔除双侧输尿导管,术后3周拔除导尿管,未发生手术并发症及术后并发症,尿控良好。结论 da-Vinci机器人辅助腹腔镜下根治性膀胱前列腺切除术可以明显减少术中出血,恢复快,缩短住院时间。机器人将复杂的盆腔腹腔镜手术变得简单易行,提高了手术的精细度和灵巧性。
Objective To investigate the feasibility and efficacy of da-Vinci robot assisted laparoscopic radical prostatectomy. Methods Male patients, 64 years old, multiple cystoscopy cystoscopy, CT without distant metastasis. Surgical use of 3 arm 2 auxiliary holes, da-Vinci robot-assisted laparoscopic total cystectomy + prostatectomy, pelvic lymph node dissection, open surgery under removal of the removed bladder, prostate, in situ double U-shaped ileal bladder surgery. The operation time, intraoperative blood loss, postoperative intestinal function recovery, postoperative complications and surgical outcomes were observed. Results The operation time was 330 min (including position display and da-Vinci robot in position for 30 min), including total cystectomy for 180 min and in situ bladder operation for 120 min. Surgery blood loss 800ml, transfusion of red blood cells 600ml, plasma 300ml. Postoperative pathology: bladder urothelial carcinoma. The bilateral ureteral catheter was removed on the 10th day after operation, and the catheter was removed 3 weeks after operation. There was no complications and postoperative complications. Urinary control was good. Conclusion da-Vinci robot assisted laparoscopic radical prostatectomy can significantly reduce intraoperative bleeding, rapid recovery, shorten the hospital stay. Robots make complex pelvic laparoscopic surgery simple and easy, increasing the sophistication and dexterity of the surgery.