机器人辅助腹腔镜下行睾丸恶性肿瘤腹膜后淋巴结清扫术的疗效及安全性
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摘要
目的:探讨机器人辅助腹腔镜下腹膜后淋巴结清扫术(RA-RPLND)治疗早期睾丸恶性肿瘤的手术技术及治疗效果。方法:2013年9月至2017年3月,3例原发性睾丸非精原细胞肿瘤根治性睾丸切除术后行RA-RPLND治疗。其中左侧1例,右侧2例,根治性睾丸切除术后病理证实为恶性混合型生殖细胞瘤1例,胚胎癌1例,胚胎性横纹肌肉瘤1例。记录手术时间、术中出血量、围手术期并发症、肠功能恢复时间、住院时间,并监测肿瘤标志物,进行手术后随访。结果:3例手术均成功完成。手术时间(144±17)min,术中出血量(110±29)ml,术后肠功能恢复时间(52±15)h,总住院时间(6.0±0.8)d。未出现肠管损伤、大血管损伤和淋巴瘘;无中转开放。2例术前临床分期为Ⅰ_a期,1例术前为Ⅰ_b期;其中1例术后病理分期为II_b期。术后随访3～18个月未见肿瘤复发及转移,无死亡病例,术后无逆向射精。其中胚胎性横纹肌肉瘤者术后行常规全身化疗,随访18个月无复发。结论:RA-RPLND治疗早期睾丸肿瘤是安全可行的,在保留正常射精、减少副损伤方面有明显的优势。
Objective:To assess the surgical techniques and effects of robot assisted laparoscopic retroperitoneal lymph node dissection(RA-RPLND).Methods:Between September 2013 and March 2017,RA-RPLND was performed using da Vinci surgical system on 3 patients with non-seminomatous germ cell tumor(NSGCT) who underwent radical orchiectomy.Of 3 tumors,one was found left,and two were right.The histological subtype include mixed germ cell tumor,embryonal carcinoma,embryonal rhabdomyosarcoma.The operating time,intraoperative blood loss,postoperative intestinal function recovery time,perioperative complications,hospital stay were recorded.Results:The procedure was successfully performed in all the 3 patients without conversion to open surgery.The mean operating time was(144±17)min,the mean intraoperative blood loss was(110±29)ml,the postoperative intestinal function recovery time was(52±15)h,and the hospital stay was(6.0±0.8)d.There were no intra-operation and post-operation complications.In a mean follow up for 3～18 months,all patients with normal antegrade ejaculation,had no local tumor recurrence and distant metastasis,and no one was dead during follow-up.Systemic chemotherapy was performed for the embryonal rhabdomyosarcoma case after surgery,and follow-up for 18 months has shown no recurrence.Conclusion:RA-RPLND is safe,effective and feasible for treatment of testicular tumor.This technique has obvious advantage in nerve-sparing and reducing side injury.
Objective:To assess the surgical techniques and effects of robot assisted laparoscopic retroperitoneal lymph node dissection(RA-RPLND).Methods:Between September 2013 and March 2017,RA-RPLND was performed using da Vinci surgical system on 3 patients with non-seminomatous germ cell tumor(NSGCT) who underwent radical orchiectomy.Of 3 tumors,one was found left,and two were right.The histological subtype include mixed germ cell tumor,embryonal carcinoma,embryonal rhabdomyosarcoma.The operating time,intraoperative blood loss,postoperative intestinal function recovery time,perioperative complications,hospital stay were recorded.Results:The procedure was successfully performed in all the 3 patients without conversion to open surgery.The mean operating time was(144±17)min,the mean intraoperative blood loss was(110±29)ml,the postoperative intestinal function recovery time was(52±15)h,and the hospital stay was(6.0±0.8)d.There were no intra-operation and post-operation complications.In a mean follow up for 3～18 months,all patients with normal antegrade ejaculation,had no local tumor recurrence and distant metastasis,and no one was dead during follow-up.Systemic chemotherapy was performed for the embryonal rhabdomyosarcoma case after surgery,and follow-up for 18 months has shown no recurrence.Conclusion:RA-RPLND is safe,effective and feasible for treatment of testicular tumor.This technique has obvious advantage in nerve-sparing and reducing side injury.
引文
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[14] Liu ZW,Zhang XQ,Hou GL,et al.Primary adult intratesticular rhabdomyosarcoma:Results of the treatment of six cases[J].Int J Urol,2011,18(2):171-174.
[15] Brian Kelly,Dara Lundon,Babatunde Rowaiye,et al.Embryonal rhabdomyosarcoma of the testis [J].Can Urol Assoc J,2011,5(1):7-10.
[16] LI RG,SUN LX,LIAO YH,et al.Adult intratesticular rhabdomyosarcoma:clinicopathologic analyses and review of literatures [J].J Clin Exp Pathol,2015,31(5):556-559.[李荣岗,孙丽霞,廖悦华,等.成人睾丸内横纹肌肉瘤临床病理分析[J].临床与实验病理学杂志,2015,31(5):556-559.]
[17] Vallier C,Savoie PH,Delpero JR,et al.External validation of the Heidenreich criteria for patient selection for unilateral or bilateralretroperitoneal lymph nodedissection for post-chemotherapy residual masses of testicular cancer[J].World J Urol,2014,32(6):1573-1578.
[18] Beck SD,Foster RS,Bihrle R,et al.Is full bilateral retroperitoneal lymph node dissection always necessary for postchemotherapy residual tumor[J]?Cancer,2007,110(6):1235-1240.
[19] Donohue JP,Foster RS,Rowland RG,et al.Nerve-sparing retroperitoneal lymphadenectomy with preservation of ejaculation[J].Urol,1990(144):287-291.
[20] Sonneveld DJ,Koops HS,Sleijfer DT,et al.Surgery versus surveillance in stage I non-seminoma testicular cancer[J].Semin Surg Oncol,1999,17(4):230-239.
[21] Williams SB,McDermott DW,Winston D,et al.Morbidity of open retroperitoneal lymph node dissection for testicular cancer:Contemporaryperioperative data[J].BJU Int,2010,105(7):918-921.
[2] Steele GS,Richie JP.Current role of retroperitoneal lymph node dissection in testicular cancer[J].Oncology,1997,11(5):717-729.
[3] Thijssens K,Vaneerdeweg W,Schrijvers D,et al.Retroperitoneal lymph node dissection as adjuvant therapy in the treatment of non-seminomatous testicular cancer [J].Acta Chir Belg,2003,103(6):599-602.
[4] SUN ZY,SUN G,SUN YH.Testicular tumor surgery[M].Shanghai:The Second Military Medical Uniersity (SMMU) Press,2006:107.[孙则禹,孙光,孙颖浩.睾丸肿瘤外科及手术学[M].上海:第二军医大学出版社,2006:107.]
[5] Davol P,Sumfest J,Rukstalis D.Robotic-assisted laparoscopic retroperitoneal lymph node dissection [J].Urology,2006,67(1):199.
[6] Cheney SM,Andrews PE,Leibovich BC,et al.Robot assisted retroperitoneal lymph node dissection:Technique and initial case series of 18 patients[J].BJU Int,2015,115(1):114-120.
[7] Williams SB,Lau CS,Josephson DY.Initial series of robot-assisted laparoscopic retroperitoneal lymph node dissection for clinicalstage I nonseminomatous germ cell testicular cancer[J].Eur Urol,2011,60(6):1299-1302.
[8] YANG GQ,CHEN GF,ZHANG X,et al.Thirteen cases report of robot assisted laparoscopic retroperitoneal lymph node dissection [J].J Clin Urology(China),2016,31(10):911-914.[杨国强,陈光富,张旭,等.机器人辅助腹腔镜腹膜后淋巴结清扫术13例报告[J].临床泌尿外科杂志,2016,31(10):911-914.]
[9] Shane M Pearce,Shay Golan,Michael A Gorin,et al.Safety and early oncologic effectiveness of primary robotic retroperitoneal lymph node dissection for nonseminomatous germ cell testicular cancer[J].Eur Urol,2017,71(3):476-482.
[10] Sun YH.Robotic urologic surgery [M].Beijing:People's Health Publishing House,2015:22.[孙颖浩.机器人泌尿外科手术学[M].北京:人民卫生出版社,2015:22.]
[11] Hinman FJ.Atlas of urologic surgery[M].Philadelphia:Saunders,1998:385-403.
[12] Spermon JR,Roeleveld TA,van der Poel HG,et al.Comparison of surveillance and retroperitoneal lymph node dissection in stage I nonseminomatous germ cell tumors[J].Urology,2002,59(6):923-929.
[13] CHEN JH,ZHOU J,YE ZQ.Textbook of laparoscopic urology[M].Beijing:People's Health Publishing House,2016:261.[陈俊汇,周军,叶章群.泌尿外科腹腔镜教程[M].北京:人民卫生出版社,2016:261.]
[14] Liu ZW,Zhang XQ,Hou GL,et al.Primary adult intratesticular rhabdomyosarcoma:Results of the treatment of six cases[J].Int J Urol,2011,18(2):171-174.
[15] Brian Kelly,Dara Lundon,Babatunde Rowaiye,et al.Embryonal rhabdomyosarcoma of the testis [J].Can Urol Assoc J,2011,5(1):7-10.
[16] LI RG,SUN LX,LIAO YH,et al.Adult intratesticular rhabdomyosarcoma:clinicopathologic analyses and review of literatures [J].J Clin Exp Pathol,2015,31(5):556-559.[李荣岗,孙丽霞,廖悦华,等.成人睾丸内横纹肌肉瘤临床病理分析[J].临床与实验病理学杂志,2015,31(5):556-559.]
[17] Vallier C,Savoie PH,Delpero JR,et al.External validation of the Heidenreich criteria for patient selection for unilateral or bilateralretroperitoneal lymph nodedissection for post-chemotherapy residual masses of testicular cancer[J].World J Urol,2014,32(6):1573-1578.
[18] Beck SD,Foster RS,Bihrle R,et al.Is full bilateral retroperitoneal lymph node dissection always necessary for postchemotherapy residual tumor[J]?Cancer,2007,110(6):1235-1240.
[19] Donohue JP,Foster RS,Rowland RG,et al.Nerve-sparing retroperitoneal lymphadenectomy with preservation of ejaculation[J].Urol,1990(144):287-291.
[20] Sonneveld DJ,Koops HS,Sleijfer DT,et al.Surgery versus surveillance in stage I non-seminoma testicular cancer[J].Semin Surg Oncol,1999,17(4):230-239.
[21] Williams SB,McDermott DW,Winston D,et al.Morbidity of open retroperitoneal lymph node dissection for testicular cancer:Contemporaryperioperative data[J].BJU Int,2010,105(7):918-921.
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