CAJ | 학술논문

目的：探讨机器人辅助完全腹腔镜下根治性膀胱全切除术加尿流改道术的临床可行性以及肿瘤学和功能预后.方法：2012年3月~2012年6月,对10例膀胱癌患者行机器人辅助完全腹腔镜下根治性膀胱全切除术加尿流改道术,其中8例行St uder 新膀胱术,2例行回肠膀胱术,所有操作均在机器人辅助腹腔镜下完成.结果：10例手术均获成功,平均手术时间为471(365~667)min ,平均出血量409(170~1200)ml .平均淋巴结清扫数目为18(9~25)枚,手术切缘均阴性.2例回肠膀胱术后1月拔除输尿管支架管；8例原位新膀胱术后1月行膀胱造影,所有病例确定没有吻合口漏后拔除尿管和双侧输尿管支架管.术后平均住院时间为12(8~26)d ,术后随访19(18~20)个月,2例出现转移,死亡1例.其余病例肾功能正常,尿控较满意.结论：根据初期的手术操作过程和随访结果,机器人辅助完全腹腔镜下根治性膀胱全切除加尿流改道术在临床上是可行的.更多的操作经验,长期和前瞻性的对照研究将有助于对这一技术的评估.
목적：탐토궤기인보조완전복강경하근치성방광전절제술가뇨류개도술적림상가행성이급종류학화공능예후.방법：2012년3월~2012년6월,대10례방광암환자행궤기인보조완전복강경하근치성방광전절제술가뇨류개도술,기중8례행St uder 신방광술,2례행회장방광술,소유조작균재궤기인보조복강경하완성.결과：10례수술균획성공,평균수술시간위471(365~667)min ,평균출혈량409(170~1200)ml .평균림파결청소수목위18(9~25)매,수술절연균음성.2례회장방광술후1월발제수뇨관지가관；8례원위신방광술후1월행방광조영,소유병례학정몰유문합구루후발제뇨관화쌍측수뇨관지가관.술후평균주원시간위12(8~26)d ,술후수방19(18~20)개월,2례출현전이,사망1례.기여병례신공능정상,뇨공교만의.결론：근거초기적수술조작과정화수방결과,궤기인보조완전복강경하근치성방광전절제가뇨류개도술재림상상시가행적.경다적조작경험,장기화전첨성적대조연구장유조우대저일기술적평고.
Objective:Toinvestigatetheclinicalfeasibilityof Robot-assistedradicalcystectomy (RARC)withto-tallyintracorporeal urinary diversion (ICUD)and to present oncologic and functional outcomes .Methods:From March2012toJune2012,RARCwithICUDwasperformedon10patientsdiagnosedpreoperativelywiththebladder urothelial carcinomas .All patients underwent ICUDfollowing RARC (ileal conduit urinary diversion for 2 patients and orthotopic ileal neobladder for 8 patients ).Results:All patients under went the laparoscopic procedure as planned . The operative ti me was 365-667 min (mean 471 min)with blood loss of 170-1 200 mL (mean 409 mL),and the numberofremovedlymphnodes was9-25 (mean18).For2patientsundergoingilealconduiturinarydiversion,the ileoureteral stents were re moved at 1st month .And for 8 patients undergoing orthotopic ileal neobladder ,the il-eoureteral stents and the urethral catheter were re moved one month after a cystogra m with confir med watertight healing .Hospital stay was 8-26 days (mean 12 days ).During the follow up period of 18-20 months (mean 19 months ),2 patients had disease recurrence and 1 died of disease .The re maining patients had satisfactory urinary continenceandnormalrenalfunctions.Conclusions:Withinitialsurgeryandshort-termfollow-up,RARCwithtotally intracorporeal urinarydiversionisfeasible.Moreextensivesurgicalexperiencesas wellaslonger-termand moreran-do mized trials will be required to better assess the appropriateness and potential of this technique .