腹腔镜下膀胱根治性切除术(附23例报告)

Laparoscopic Radical Cystectomy: Report of 23 Cases

目的探讨腹腔镜下膀胱根治性切除术的手术方法和临床效果。方法浸润性膀胱癌23例,无远处转移,采用5个trocar,腹腔镜下行膀胱根治性切除术、前列腺切除,下腹正中做7cm切口,取出切除的膀胱、前列腺,尿流改道方式包括17例回肠膀胱术、3例回肠代膀胱术、1例输尿管乙状结肠吻合、2例输尿管皮肤造口。结果手术时间4~10h,平均7.5h。出血量100~800ml,平均311ml,1例输血1000ml,余22例未输血。术后2例麻痹性肠梗阻,经保守治疗痊愈,无其他并发症。术后随访2~32个月,2例因远处转移死亡,21例健在,无瘤生存2~32个月,平均17个月,肾功能正常,B超及IVU检查1例轻度双肾积水。结论腹腔镜下膀胱根治性切除术安全可行,创伤小,出血少,恢复快。

Objective To study the technique and outcomes of laparoscopic radical cystectomy (LRC). Methods A total of 23 patients with bladder cancer including 22 men and 1 women were enrolled in this study. The mean age of the patients was 61 years (ranged 50-74). No distant metastasis was found in the cases. LRC was performed using 5 trocars. After the prostate was resected, a 7-cm middle abdominal incision was made and the bladder and prostate were removed. Afterwards, the patients received urinary diversion surger...