机器人辅助腹腔镜手术在泌尿系统肿瘤治疗中的应用进展

Application progress of robot assisted laparoscopic surgery in the treatment of urologic tumors

关键词:  机器人  腹腔镜  手术  泌尿系统  肿瘤

Key words:  robot  laparoscopy  operation  urinary system  tumor

摘要:

机器人操作系统能将盆腔内精细的高难度操作变得相对简单，在尿流改道的操作中具有明显优势。机器人辅助腹腔镜下前列腺切除术，术中出血更少，术后在勃起功能和排尿功能恢复方面更有优势，正在取代传统开放手术和腹腔镜手术，成为治疗局限性前列腺癌的金标准。机器人辅助膀胱根治性切除术与标准腹腔镜手术相比，具有学习曲线更短，并发症发生率更低和胃肠功能恢复更快等优势。机器人手术相对于传统腹腔镜手术，在肾部分切除手术方面有明显优势，能轻松实现肾脏深层髓质和浅层皮质的双层关闭，缩短安全热缺血时间，能最大限度保护肾功能。此外，对于肾门部的肿瘤行保留肾单位的手术时更有优势，对于血管的暴露更加清晰，提高了手术的安全性，被认为是首选的微创保留肾单位的手术方式。机器人辅助腹腔镜肾肿瘤根治术主要应用于复杂肾根治术，如肾癌伴下腔静脉瘤栓的手术治疗。本文就机器人手术系统在泌尿系统肿瘤治疗中的现状作一综述。

Abstract:

Robotic surgical system is more and more widely used in the Department of Urology. The robot operating system can make the complicated and difficult operation in pelvic cavity relatively simple, and has obvious advantages in the operation of urinary diversion. Robot assisted laparoscopic prostatectomy with less intraoperative bleeding, fast postoperative recovery, advantages on erectile function and urinary function, is to replace the traditional open surgery and laparoscopic surgery and has become the gold standard for the treatment of localized prostate cancer. Compared with standard laparoscopic surgery, robot assisted radical cystectomy has the advantages of shorter learning curve, lower incidence of complications and faster recovery of gastrointestinal function. Robotic surgery, compared with traditional laparoscopic surgery, has obvious advantages in partial nephrectomy and can easily achieve double closure of the renal medulla and cortex, shorten the warm ischemia time, and maximize the protection of renal function. It has advantages in nephron sparing surgery for renal hilar tumors with clear exposure of the blood vessels and improved safety. Robotic surgery is considered to be the first choice for minimally invasive nephron sparing surgery. Robot assisted laparoscopic radical nephrectomy is mainly used in the treatment of complicated renal resection, such as renal carcinoma with inferior vena cava tumor thrombus. The current application status of robot assisted laparoscopic surgery in the treatment of urologic tumors is reviewed in this paper.