腹腔镜根治性膀胱切除术中减少出血的技术改进168例报道

Technical improvements to reduce intraoperative bleeding in laparoscopic radical cystectomy:168 cases report

目的:探讨有效减少腹腔镜根治性膀胱切除术(LRC)中出血的方法和技术。方法:回顾性分析2015年1月至2023年12月我院实施LRC手术的168例男性膀胱肿瘤患者。改进术中出血的方法包括切除膀胱前先阻断双侧脐动脉以减少膀胱和前列腺的血供;切除闭孔淋巴结沿盆壁和骶骨前解剖层面进行,将闭孔淋巴脂肪组织整块游离至膀胱外侧,显露切断淋巴组织与盆壁和骶骨之间的血管交通支;精细解剖膀胱侧韧带及前列腺侧血管蒂,Hem-o-lok夹闭后切断;游离阴茎背深静脉复合体(DVC),充分显露两侧壁,缝扎后将其切断。结果:168例患者手术时间120~190 min,平均155 min。术中出血20~300 ml,平均86 ml,输血4.17%。术中无严重并发症、无中转开放手术。术后无继发性出血发生。结论:通过对术中控制出血方法和技术的改进,可有效减少LRC术中出血,降低严重术中并发症的发生。

Objective:To explore the technology and method to effectively reduce intraoperative bleeding in laparoscopic radical cystectomy(LRC).Method:168 male patients with bladder neoplasms underwent LRC admitted in our hospital from 2015 to 2023were retrospectively analysed.Methods for improving intraoperative bleeding included the following that block the bilateral umbilical arteries to reduce the blood supply to the bladder and prostatebefore removing the bladder;resection the obturator lymph nodes along the anatomical level of the pelvic wall and anterior sacrum,and free the entire obturator lymphatic fat tissue to the lateral wall of bladder to expose and cut off the lymphatic tissue and the vascular communication branches between the pelvic wall and the sacrum;dissect the bladder lateral ligament and prostatic vascular pedicle carefully,then block it by Hem-o-lok and cut it off;free the dorsal vascular complex(DVC)and expose the bilateral wall of it clearly,suture and cut off DVC.Results:Operative time of 168 patients was 120-190min,average 155min.Intraoperative bleeding was 20-300 ml,average 86 ml,and the rate of intraoperative blood transfusion was 4.17%.There were no serious intraoperative complications,conversion to open surgery or postoperative secondary bleeding.Conclusion:Intraoperative bleeding and the occurrence of serious complications can be effectively reduced by improving the methods and techniques of intraoperative bleeding controlling LRC.