机器人辅助腹腔镜、传统腹腔镜和开放手术3 种 膀胱癌根治性全膀胱切除加回肠膀胱术的围手术期疗效比较

Objective To compare the perioperative outcomes of robot-assisted laparoscopic radical cystectomy（RARC），conventional laparoscopic radical cystectomy（LRC），and open radical cystectomy （ORC）. Method We retrospectively analyzed data of 248 patients who underwent radical cystectomy and ileal conduit in single operation group，Department of Urology，Zhongshan Hospital of Fudan University from Jan.2009 to Dec.2018，including 87 cases of robot-assisted laparoscopic surgery，32 cases of traditional laparoscopic surgery，and 129 cases of open surgery.The gender，age，body mass index（BMI）， concomitant chronic diseases，operation time，intraoperative blood transfusion rate，postoperative blood transfusion rate，ICU rate，postoperative red blood cell decline，postoperative hemoglobin decline， postoperative albumin decline，postoperative creatinine elevation，postoperative hospital stay，total hospitalization costs，and complication rates were compared. Results All 248 cases of surgery were successful without conversion to other surgical methods. There were no significant differences in age， gender，BMI，history of hypertension，diabetes，and heart disease between the three groups. The robotic surgery group was significantly lower than the laparoscopic group and the open group in terms of operation time，postoperative red blood cell decline，hemoglobin decrease，and albumin decrease（P<0.05）.Robotic surgery was also significantly lower than open surgery in terms of postoperative hospital stay and intraoperative blood transfusion rate（P<0.05）. The laparoscopic group was significantly lower than the open group in terms of red blood cell decline and hemoglobin decline（P<0.05）.The total hospitalization cost of robotic surgery was significantly higher than that of the laparoscopic and open groups（P<0.05）.In terms of postoperative complications，although the incidence of robotic surgery was lower than that of the laparoscopic group and the open group，the difference was not statistically significant. Conclusions Robot-assisted laparoscopic radical cystectomy and ileal bladder surgery has the advantages of shorter operation time，less trauma and quicker recovery than traditional laparoscopic and open surgery. Under economically feasible conditions，it is the preferred surgical method for muscle invasive bladder cancer. [ABSTRACT FROM AUTHOR]