達文西機械手臂輔助體內原位J-pouch迴腸膀胱重建的成效

曾浩翔、黃志平

中國醫藥大學附設醫院 泌尿部

Outcome of Robotic Radical Cystectomy with Intracorporeal J-Pouch Neobladder in Muscle-Invasive Bladder Cancer Patient

Chen Hao Xiang, Chi-Ping Huang

Department of Urology, China Medical University Hospital, Taichung, Taiwan

Purpose:

Orthotopic urinary diversion allows the patient to maintain continent ability after radical cystectomy. There are several surgical techniques for neobladder reconstructions that have been described in the past. In this study, we present the preliminary outcome of the robotic radical cystectomy with intracorporeal J-pouch neobladder reconstruction in China Medical University Hospital.

Materials and Methods:

There were 17 patients who underwent robotic-assisted radical cystectomy with intracorporeal J pouch orthotopic neobladder reconstruction. The time to recurrence is defined as the time from the date of operation to the date of radiological progression. The early complication is defined as any complication that occurs within 90 days after the operation while late complication is defined as those that occur after 90 days.

Results: The median age of the included patient was 61(range 36-81) years old. All of the patients underwent robotic-assisted radical cystectomy with bilateral pelvic lymph node dissection and intracorporeal J pouch orthotopic neobladder reconstruction. The median length of hospital stay is 19(range 13-29) days. The median time of post-op Foley catheter is 19(range 14-34) days. At the time of data collection, there were 2 patients with disease recurrence. 1 of the patients expired due to cardiac arrest. That patient had refractory VT secondary to underlying sick sinus syndrome. The survival time of this patient is 17.8months. None of the remaining 15 patients has recurrence. 5/17(29.4%) of the patients had Clavien-Dindo grade III complications. There were overlapping of the patients who have early and late complications. There were 4 early complications and 5 late complications in total. 12/17 patients have postoperative hydronephrosis with 8 left solitary or more severe hydronephrosis, 3 bilateral hydronephrosis and 2 right hydronephrosis. Most of the hydronephrosis is self-limiting and does not lead to renal function deterioration. Only 3 of the 12 patients with hydronephrosis required a percutaneous nephrostomy tube and Double J ureteral stent placement.

Conclusion: 

Intracorporeal J-pouch orthotopic neobladder is a safe technique for orthotopic neobladder reconstruction.