根治性膀胱前列腺切除术治疗膀胱肿瘤14例临床分析

The modifications of surgical techniques in radical cystectomy and prostatectomy

目的 :探讨根治性膀胱前列腺切除术中控制膀胱侧韧带和前列腺背静脉丛损伤出血的方法。方法 :对14例男性膀胱癌患者施行根治性膀胱前列腺切除术 ,术中运用了顺行、逆行相结合方法控制侧韧带切除膀胱 ,连续缝合完成背静脉丛的结扎切断后切除前列腺。结果:14例手术均顺利完成。术中膀胱侧韧带及背静脉丛损伤出血得到了有效控制 ,出血量明显减少 ,平均 4 0 0 ml;手术时间缩短 ,平均 85 min。术后无并发症发生。平均随访 18个月 ,1例局部肿瘤复发 ,其余患者无瘤存活。 结论:合理地控制膀胱侧韧带、结扎后切断前列腺背静脉丛对提高根治性膀胱前列腺切除术的安全性和普及性有重要作用 ,同时为原位肠代膀胱术提供了良好的手术平台。

Objective: To study the techniques in preventing severe bleeding in radical cystectomy and prostatectomy. Methods: 14 cases with bladder cancers were performed with radical cystectomies and prostectomies. The bladder lateral ligaments were ligated antegradly and retrogradly. The dorsal vein complexes were made sure with continuous sutures. Results: The lateral ligaments and dorsal vein complexes were managed effectively, with a result of less blood lost (mean <400 ml) and shorter operative time (mean 85 min). Conclusion: Using the modified techniques in managing the bladder lateral ligaments and dorsal vein complexes, it is a safer and easier operation in radical cystectomy and prostatectomy.