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目的:探讨应用Da Vinci机器人治疗精囊原发性恶性肿瘤的临床效果。方法:回顾性分析2013年1月~2016年8月解放军总医院应用Da Vinci机器人实施的4例精囊原发性恶性肿瘤手术患者的临床资料。结果:4例患者中,2例实施精囊肿瘤切除术,2例实施膀胱、前列腺、精囊切除术,其中1例术前发现盆腔淋巴结转移患者同时实施了盆腔淋巴结清扫术。4例手术均获成功,术中无直肠、大血管损伤等严重并发症。手术时间50~180min,术中失血量50~300ml。精囊肿瘤切除患者术后5天出院,膀胱、前列腺、精囊切除患者分别于术后7天和11天出院。术后病理回报,2例精囊腺癌,1例精囊未分化癌,1例精囊肉瘤。随访6个月~2年,2例精囊腺癌均无瘤存活。1例精囊未分化癌于术后1年发现局部复发,1例精囊肉瘤在术后6个月因肿瘤多发转移死亡。结论:精囊原发性恶性肿瘤恶性度高,手术操作难度较大。Da Vinci机器人操作精巧灵活,便于术野和肿瘤显露,应用于精囊原发性恶性肿瘤的手术效果良好。
Objective: To investigate the clinical effect of Da Vinci robot in the treatment of primary malignant seminal vesicle. Methods: The clinical data of 4 cases of primary malignant tumor treated by Da Vinci robot from January 2013 to August 2016 in PLA General Hospital were retrospectively analyzed. Results: Among 4 patients, 2 patients underwent resection of seminal vesicle and 2 patients underwent bladder, prostate and seminal vesicle resection. Among them, pelvic lymphadenectomy was performed in 1 patient with pelvic lymph node metastasis. 4 cases were successful in operation, there was no serious complications such as rectum and great vessel injury during operation. Surgery time 50 ~ 180min, intraoperative blood loss 50 ~ 300ml. Seminal vesicle resection patients were discharged 5 days after surgery, bladder, prostate, seminal vesicle resection were discharged 7 days and 11 days after surgery. Postoperative pathological findings, 2 cases of seminal vesicle adenocarcinoma, 1 case of seminal vesicle undifferentiated carcinoma and 1 case of seminal vesicle sarcoma. Follow-up 6 months to 2 years, 2 cases of seminal vesicle adenocarcinoma tumor-free survival. One case of undifferentiated seminal vesicle showed local recurrence 1 year after operation, and 1 case of sarcoma sarcoma died of multiple tumor metastases at 6 months after operation. Conclusion: Seminal vesicle primary malignancies are highly malignant and difficult to operate. Da Vinci robots operate exquisitely and flexibly, which is convenient for the operation field and the tumor to be revealed. The operation applied to the seminal vesicle primary malignant tumor is good.