本文選題：非肌層浸潤(rùn)性膀胱癌 + 經(jīng)尿道膀胱腫瘤電切術(shù)��； 參考：《華中科技大學(xué)》2016年博士論文

【摘要】：目的：研究膀胱腫瘤電切術(shù)切緣范圍以及術(shù)后病理證實(shí)切緣是否陽(yáng)性與術(shù)后腫瘤復(fù)發(fā)以及腫瘤原位復(fù)發(fā)之間的相關(guān)性,藉此探討更為合理的膀胱腫瘤電切術(shù)切緣。方法：回顧性分析2011年1月至2013年6月期間同濟(jì)醫(yī)院泌尿外科收治的Ta及T1期非肌層浸潤(rùn)性膀胱癌(NMIBC)患者的資料共143例。按不同手術(shù)醫(yī)生施行手術(shù)時(shí)的切緣范圍分為10mm,15mm和20mm三組,術(shù)后按臨床及病理分期和危險(xiǎn)度行相應(yīng)的膀胱內(nèi)藥物灌注治療。每例患者維持24個(gè)月的術(shù)后隨訪,觀察腫瘤復(fù)發(fā)及原位復(fù)發(fā)的情況。采用Log-rank檢驗(yàn)法比較三組之間腫瘤復(fù)發(fā)及原位復(fù)發(fā)的差異。采用Cox風(fēng)險(xiǎn)回歸分析法,以腫瘤復(fù)發(fā)作為終止事件,對(duì)腫瘤大小、本次為原發(fā)／復(fù)發(fā)、病理分級(jí)、電切范圍、切緣是否為陽(yáng)性與腫瘤復(fù)發(fā)、及原位復(fù)發(fā)之間進(jìn)行多因素風(fēng)險(xiǎn)分析。采用Kaplan-Meier法,以腫瘤復(fù)發(fā)為終點(diǎn),分別對(duì)腫瘤復(fù)發(fā)及原位復(fù)發(fā)進(jìn)行生存分析。結(jié)果：腫瘤的大小,本次腫瘤為原發(fā)/復(fù)發(fā),腫瘤病理分級(jí),電切范圍,以及手術(shù)切緣陽(yáng)性/陰性的差異均為膀胱腫瘤的復(fù)發(fā)的影響因素(P0.05)。而對(duì)于膀胱腫瘤原位復(fù)發(fā)率,膀胱腫瘤的大小,腫瘤的病理分級(jí),手術(shù)電切的范圍,以及手術(shù)切緣陽(yáng)性/陰性的差異均為其影響因素。腫瘤直徑3cm,本次腫瘤為復(fù)發(fā),電切術(shù)后切緣陽(yáng)性是影響NMIBC復(fù)發(fā)的獨(dú)立危險(xiǎn)因素。而增加切緣范圍是NMIBC復(fù)發(fā)的獨(dú)立保護(hù)因素。電切術(shù)后切緣陽(yáng)性為NMIBC原位復(fù)發(fā)的獨(dú)立危險(xiǎn)因素,增加切緣范圍是NMIBC原位復(fù)發(fā)的獨(dú)立保護(hù)因素(p0.05)。與15mm及20mm的患者相比,切緣為10mm.的患者復(fù)發(fā)率增加(p=0.005)。切緣陽(yáng)性與陰性患者相比,復(fù)發(fā)率增高(p0.001)。與15mm及20mm的患者相比,切緣為10mm的患者原位復(fù)發(fā)率增加(p0.001)。切緣陽(yáng)性患者與陰性患者相比,其原位復(fù)發(fā)率增加(p=0.000)。與1Omm及15mm切緣的患者相比,切緣20mm的患者TURBT手術(shù)的并發(fā)癥發(fā)生率明顯增加(p0.05)。結(jié)論：術(shù)后病理結(jié)果表明,切緣陽(yáng)性明顯增加了膀胱癌患者的復(fù)發(fā)及原位復(fù)發(fā)率。將切緣范圍定為15mm,可明顯降低膀胱癌患者的復(fù)發(fā)率及原位復(fù)發(fā)率,同時(shí)又不顯著增加術(shù)后并發(fā)癥的發(fā)生。值得在臨床工作中進(jìn)一步推廣研究。目的：對(duì)比分析機(jī)器人輔助腹腔鏡、傳統(tǒng)腹腔鏡以及開放手術(shù)下膀胱根治性切除術(shù)+輸尿管皮膚造口術(shù)的圍手術(shù)期資料及并發(fā)癥情況。方法：入組2010年1月-2015年10月我院行膀胱根治性切除術(shù)+輸尿管皮膚造口術(shù)患者共111名,其中行開放手術(shù)者73名,行腹腔鏡手術(shù)者30名,行機(jī)器人輔助腹腔鏡手術(shù)者8名,分析各組手術(shù)時(shí)間,術(shù)中出血量,輸血量,進(jìn)食時(shí)間,拔管時(shí)間,術(shù)后住院時(shí)間等圍手術(shù)期情況和并發(fā)癥情況。結(jié)果：全部手術(shù)均順利完成,三組患者術(shù)后進(jìn)食時(shí)間及術(shù)后住院時(shí)間無(wú)差異(p0.05),開放組手術(shù)時(shí)間為240min (210-300min),低于腹腔鏡組手術(shù)時(shí)間308min(240-431min)(p=0.002),而開放組和機(jī)器人組,腹腔鏡組和機(jī)器人組在手術(shù)時(shí)間方面無(wú)差異。機(jī)器人組的術(shù)中出血量為200ml (150-300ml)，小于開放組1000m1(600-1900m1)(p=0.001)和腹腔鏡組800ml (375-1300ml) (p=0.041),開放組和腹腔鏡組出血量無(wú)差異。在術(shù)中輸血方面,腹腔鏡組及機(jī)器人組輸紅細(xì)胞及血漿均小于開放組(p0.05),腹腔鏡組和機(jī)器人組兩組間術(shù)中輸紅細(xì)胞及血漿無(wú)差異。三組間TNM分期、淋巴結(jié)陽(yáng)性率及病理分級(jí)均無(wú)明顯差異。三組患者之間的手術(shù)并發(fā)癥差異無(wú)統(tǒng)計(jì)學(xué)意義,以Clavien-Dindo評(píng)分對(duì)并發(fā)癥進(jìn)行分級(jí),三組并發(fā)癥分級(jí)無(wú)統(tǒng)計(jì)學(xué)差異。結(jié)論：機(jī)器人輔助腹腔鏡下根治性膀胱切除術(shù)+輸尿管皮膚造口術(shù)具有創(chuàng)傷小,術(shù)中出血少,術(shù)后恢復(fù)快的優(yōu)勢(shì),是治療浸潤(rùn)性膀胱癌安全有效的手術(shù)方法。目的：比較分析機(jī)器人輔助腹腔鏡、傳統(tǒng)腹腔鏡以及開放手術(shù)下膀胱根治性切除術(shù)+Bricker回腸膀胱術(shù)的圍手術(shù)期資料及并發(fā)癥情況。方法：入組2010年1月-2015年10月我院行膀胱根治性切除術(shù)及Bricker回腸代膀胱術(shù)的132例膀胱癌患者,其中行開放手術(shù)者69名,行腹腔鏡手術(shù)者57名,行機(jī)器人輔助腹腔鏡手術(shù)者6名,比較各組手術(shù)時(shí)間,術(shù)中出血量,輸血量,進(jìn)食時(shí)間,拔管時(shí)間,術(shù)后住院時(shí)間等圍手術(shù)期情況和術(shù)后并發(fā)癥情況。結(jié)果：全部手術(shù)均順利完成,三組患者在術(shù)后進(jìn)食時(shí)間和拔盆腔引流管時(shí)間方面無(wú)差異。開放組手術(shù)時(shí)間為398min (360-450min),低于腹腔鏡組手術(shù)時(shí)間435min(390-510min) (p=0.011),而機(jī)器人手術(shù)時(shí)間338min (330-480min)與開放組和腹腔鏡組之間無(wú)差異。在術(shù)中出血量方面,機(jī)器人組出血量為300ml (200-375ml),低于腹腔鏡組出血量700ml(400-1200ml)(p=0.043)和開放組出血量1200ml(800-2000ml) (p0.001),腹腔鏡組出血量低于開放組(p=0.003)。機(jī)器人組術(shù)中所輸紅細(xì)胞量0U(0-OU)低于開放組6U(4-7.5U)(p=0.001),與腹腔鏡組無(wú)差異,而腹腔鏡組術(shù)中輸紅細(xì)胞量2U(0-4U)低于開放組(p0.001)。術(shù)中輸血漿量三組總體存在差異(p=0.040),但兩兩比較無(wú)差異。在出院時(shí)間方面,機(jī)器人組術(shù)后出院時(shí)間11天(10-19.5天),少于開放組術(shù)后住院時(shí)間19天(14-23天)(p=0.027),腹腔鏡組術(shù)后住院時(shí)間為15天(13-20天),與開放組及機(jī)器人組均無(wú)差異。三組間腫瘤TNM分期、淋巴結(jié)陽(yáng)性率及病理分級(jí)均無(wú)明顯差異。三組患者之間的手術(shù)并發(fā)癥差異無(wú)統(tǒng)計(jì)學(xué)意義,以Clavien-Dindo評(píng)分對(duì)并發(fā)癥進(jìn)行分級(jí),三組并發(fā)癥分級(jí)無(wú)統(tǒng)計(jì)學(xué)差異。結(jié)論：機(jī)器人輔助腹腔鏡下根治性膀胱切除術(shù)+Bricker回腸膀胱術(shù)具術(shù)中出血少,術(shù)中創(chuàng)傷小,術(shù)后恢復(fù)快的優(yōu)勢(shì),是治療浸潤(rùn)性膀胱癌安全有效的手術(shù)方法。
[Abstract]:Objective: To study the range of cutting edge of bladder tumor resection and the correlation between the positive margin of the resection and the recurrence of tumor and the recurrence of tumor in situ, so as to explore a more reasonable cutting edge of bladder tumor resection. Method: a retrospective analysis of the Ta in Tongji Hospital from January 2011 to June 2013. 143 cases of non myometrium invasive bladder cancer (NMIBC) patients with T1 were divided into 10mm, 15mm and 20mm three groups according to the operation of different surgeons. After operation, the corresponding intravesical infusion therapy was performed according to the clinical and pathological stages and risk. Each case was followed up for 24 months and observed the recurrence and in situ of the tumor. Log-rank test was used to compare the difference of tumor recurrence and in situ recurrence between the three groups. Using the Cox risk regression analysis, the tumor recurrence was used as the termination event, the tumor size, this time was primary / recurrence, the pathological grade, the electric cutting range, the positive margin of the cutting edge and the recurrence of the tumor, and the recurrence of the tumor in situ. Risk analysis. The Kaplan-Meier method was used to analyze the recurrence of tumor and in situ recurrence at the end of tumor recurrence. Results: the size of the tumor was the primary / recurrence of the tumor, the pathological grade of the tumor, the scope of the resection, and the difference of the positive / negative of the surgical margin were the influencing factors of the recurrence of the bladder tumor (P0.05). The recurrence rate of Yu Bangguang's tumor in situ, the size of the bladder tumor, the pathological classification of the tumor, the scope of the surgical resection, and the difference of the positive / negative of the surgical margin were all the factors affecting the tumor. The tumor was 3cm, the tumor was recurrent, and the positive margin of the resection was an independent risk factor for the recurrence of NMIBC. The increase of the margin of cutting margin was the recurrence of NMIBC. Independent protective factors. The positive margin of tangent margin after electrocutting was an independent risk factor for the recurrence of NMIBC in situ. Increasing the margin of cutting edge was an independent protective factor for the recurrence of NMIBC in situ (P0.05). Compared with 15mm and 20mm, the recurrence rate of patients with 10mm. was increased (p=0.005). Compared with negative patients, the recurrence rate increased (p0.001) and 15mm (p0.001). Compared with the patients with 20mm, the recurrence rate of the patients with 10mm was increased (p0.001). The incidence of in situ recurrence was increased (p=0.000) compared with the negative patients (p=0.000). The incidence of TURBT surgery in patients with 20mm was significantly increased (P0.05) compared with those with 1Omm and 15mm margin. Conclusion: the postoperative pathological results showed that the margin Yang of the patients. The recurrence rate and in situ recurrence rate of bladder cancer patients are obviously increased. The margin range is 15mm, which can obviously reduce the recurrence rate and in situ recurrence rate of bladder cancer patients. At the same time, it does not significantly increase the incidence of postoperative complications. The perioperative data and complications of endoscopic and open radical cystectomy plus ureterostomy. Methods: a total of 111 patients were treated with radical cystectomy and ureterostomy in October January 2010 -2015 years, including 73 open operations, 30 laparoscopic surgery, and a robot. 8 patients were assisted by laparoscopy. The operation time, the amount of bleeding, the amount of blood transfusion, the time of feeding, the time of eating, the time of extubation, the postoperative hospitalization time and other complications. Results: all the operations were successfully completed. There was no difference between the three groups after the operation and the time of postoperative hospitalization (P0.05), and the operation time of the open group was 240Min (210-300min) less than 308min (240-431min) (p=0.002) in the laparoscopy group, and there was no difference in the operation time between the open group and the robot group, the laparoscopic group and the robot group. The intraoperative bleeding amount of the robot group was 200ml (150-300ml), less than the open group 1000m1 (600-1900m1) (p=0.001) and the laparoscopy group 800ml (375-1300ml) (p=0.041). In the intraoperative blood transfusion, the transfusion of red cells and plasma in the laparoscopic group and the robot group were less than the open group (P0.05). There was no difference between the two groups in the laparoscopic group and the robot group. There was no significant difference in the TNM staging, the positive rate of lymph nodes and the pathological grade between the three groups. The three groups were between the two groups. There was no statistically significant difference in surgical complications. The complications were graded by Clavien-Dindo score. There was no statistical difference between the three groups. Conclusion: the robot assisted laparoscopic radical cystectomy plus ureterostomy has less trauma, less bleeding and rapid recovery after operation. It is a treatment for invasive bladder cancer. Objective: To compare and analyze the perioperative data and complications of robot assisted laparoscopy, traditional laparoscopy and radical cystectomy for +Bricker ileocystectomy. Methods: radical cystectomy and Bricker ileum cystectomy were performed in October January 2010 -2015. 132 cases of bladder cancer, including 69 open surgery, 57 laparoscopic surgery and 6 robot assisted laparoscopic surgery, compared each group of operation time, intraoperative bleeding, blood transfusion, feeding time, extubation time, postoperative hospital time and other perioperative conditions and postoperative complications. Results: all the operations were finished smoothly. There was no difference between the three groups in the three groups. The operation time in the open group was 398min (360-450min), lower than that of the laparoscopic group, 435min (390-510min) (p=0.011), and there was no difference between the robotic operation time 338min (330-480min) and the open and open group and the laparoscopy group. The amount of hemorrhage in the human group was 300ml (200-375ml), lower than the amount of 700ml (400-1200ml) in the laparoscope group (p=0.043) and the open group, 1200ml (800-2000ml) (p0.001), and the amount of hemorrhage in the laparoscope group was lower than that in the open group (p=0.003). The amount of erythrocyte 0U (0-OU) lost in the operation of the robot group was lower than that in the open group, but there was no difference between the laparoscopy group and the laparoscope group. 2U (0-4U) in endoscopic group was lower than that in open group (p0.001). The total number of blood transfusion in three groups was different (p=0.040), but there was no difference in 22. In the discharge time, the discharge time of the robot group was 11 days (10-19.5 days) after operation, less than 19 days (14-23 days) after the operation of the open group (14-23 days), and the time of hospital stay after the laparoscopy group. There was no difference between the open group and the robot group for 15 days (13-20 days). There was no significant difference in TNM staging, lymph node positive rate and pathological grade between the three groups. There was no statistical difference between the three groups. The complications were graded by Clavien-Dindo score, and there was no statistical difference between the three groups of complications. Conclusion: machine +Bricker ileocystectomy with human assisted laparoscopic radical cystectomy is a safe and effective surgical method for the treatment of invasive bladder cancer with less bleeding, less trauma and quick recovery.
【學(xué)位授予單位】：華中科技大學(xué)
【學(xué)位級(jí)別】：博士
【學(xué)位授予年份】：2016
【分類號(hào)】：R737.14

【相似文獻(xiàn)】

相關(guān)期刊論文 前10條

1 張麗;翟娟娟;;機(jī)器人手術(shù)的應(yīng)用[J];全科護(hù)理;2010年13期

2 武少杰;;一個(gè)通過(guò)觸診能夠自動(dòng)完成診斷任務(wù)的先進(jìn)的機(jī)器人系統(tǒng)[J];國(guó)外醫(yī)學(xué).生物醫(yī)學(xué)工程分冊(cè);1988年03期

3 朱帆三;;一種通過(guò)觸摸而自動(dòng)診斷的先進(jìn)機(jī)器人系統(tǒng)[J];國(guó)外醫(yī)學(xué).生物醫(yī)學(xué)工程分冊(cè);1988年05期

4 索鴻英;形形色色的機(jī)器人[J];世界科學(xué)技術(shù);1998年02期

5 劉林森;;機(jī)器人——信息化時(shí)代的白衣天使[J];科學(xué)之友(A版);2008年03期

6 胡宇川,季林紅;從醫(yī)學(xué)角度探討偏癱上肢康復(fù)訓(xùn)練機(jī)器人的設(shè)計(jì)[J];中國(guó)臨床康復(fù);2004年34期

7 王田苗;;為什么機(jī)器人會(huì)用于臨床[J];中國(guó)醫(yī)藥生物技術(shù);2007年02期

8 伍勝;;機(jī)器人在食品包裝中的應(yīng)用[J];食品安全導(dǎo)刊;2010年06期

9 楊鑫;李占賢;徐衛(wèi)國(guó);;外科手術(shù)機(jī)器人的研究現(xiàn)狀與進(jìn)展[J];河北聯(lián)合大學(xué)學(xué)報(bào)(醫(yī)學(xué)版);2012年02期

10 F.Bortz;張建新;;H.西蒙關(guān)于制造聰明的機(jī)器人的談話[J];心理學(xué)動(dòng)態(tài);1985年03期

相關(guān)會(huì)議論文 前10條

1 胡春華;范勇;朱紀(jì)洪;孫增圻;;空中機(jī)器人的研究現(xiàn)狀與發(fā)展趨勢(shì)[A];2005年中國(guó)智能自動(dòng)化會(huì)議論文集[C];2005年

2 陳衛(wèi)東;;服務(wù)機(jī)器人的技術(shù)發(fā)展及微特電機(jī)在其中的應(yīng)用[A];第十屆中國(guó)小電機(jī)技術(shù)研討會(huì)論文集[C];2005年

3 肖玉林;侍才洪;陳煒;李浩;張西正;;救援機(jī)器人的現(xiàn)狀及發(fā)展趨勢(shì)(綜述)[A];天津市生物醫(yī)學(xué)工程學(xué)會(huì)第三十四屆學(xué)術(shù)年會(huì)論文集[C];2014年

4 鄭亞青;吳建坡;;岸邊集裝箱宏-微起重機(jī)器人的機(jī)構(gòu)、結(jié)構(gòu)設(shè)計(jì)及運(yùn)動(dòng)仿真[A];2009海峽兩岸機(jī)械科技論壇論文集[C];2009年

5 王靜;邊繼東;張大慧;林峰華;張宏;;管道定量采樣機(jī)器人系統(tǒng)設(shè)計(jì)[A];2009全國(guó)虛擬儀器大會(huì)論文集（二）[C];2009年

6 黃海明;楊雷;宋躍;賴思沅;;智能保安巡邏機(jī)器人[A];2009全國(guó)虛擬儀器大會(huì)論文集（二）[C];2009年

7 王明輝;馬書根;李斌;;獨(dú)立操作型可重構(gòu)機(jī)器人群體的動(dòng)態(tài)層次體系結(jié)構(gòu)研究[A];第八屆全國(guó)信息獲取與處理學(xué)術(shù)會(huì)議論文集[C];2010年

8 譚金林;劉明英;梁建民;;機(jī)器人硬件電路設(shè)計(jì)[A];1995年中國(guó)智能自動(dòng)化學(xué)術(shù)會(huì)議暨智能自動(dòng)化專業(yè)委員會(huì)成立大會(huì)論文集（下冊(cè)）[C];1995年

9 許家中;孔祥冰;尤波;李長(zhǎng)峰;禹鑫q，

本文編號(hào)：2035676