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腹腔镜下全膀胱切除、去结肠带乙状结肠原位新膀胱术(附71例报告) 被引量:13

Construction of Detenial Sigmoid Neobladder after Laparoscopic Radical Cystectomy:Report of 71 Cases
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摘要 目的总结膀胱癌腹腔镜下全膀胱切除、去结肠带乙状结肠原位新膀胱术的经验。方法2002年8月~2006年5月,治疗浸润性膀胱癌71例,手术包括:①腹腔镜下行根治性全膀胱切除;②经5~7cm长腹壁造口取出切除物,取乙状结肠15~20cm,剔除对系膜的两条结肠带及其带间的环形肌层和浆肌层,构建新膀胱储尿囊;③完成储尿囊与后尿道的吻合,或关闭腹壁后腹腔镜下行储尿囊与后尿道吻合(26例)。结果71例手术时间240~390min。其中腹腔镜下全膀胱切除术80~270min(平均180min),开放手术时间160~240min(平均140min)。术后4~8d恢复饮食,3~4周拔除输尿管支架管,4周拔除尿管。术后3个月平均储尿囊压力22.0cmH20(17~38cmH20),平均储尿囊容量340ml(200~410ml),残余尿量(25ml(60例(10ml),平均最大尿流率12ml/s(7.5~22ml/s)。静脉肾盂造影单侧肾积水1例,肠漏3例,储尿囊尿道吻合口狭窄2例,输尿管反流4例。15例夜间偶有尿失禁。术前39例勃起功能正常者中,术后20例恢复勃起功能。71例术后随访6~51个月,平均32个月,肿瘤复发或转移11例。结论腹腔镜下膀胱癌根治切除术创伤小,出血少,恢复快,盆腔淋巴结清扫彻底,是全膀胱切除手术中的一种很有前景的方法。全去带乙状结肠新膀胱术具有手术操作简单、需用肠段短、储尿囊在原位、尿液自尿道可控排出、术后并发症少等优点,具有较好的应用价值。 Objective To report our experience on construction of detenial sigmoid neobladder after laparoscopic radical cystectomy in 71 cases.Methods From August 2002 to May 2006,a total of 71 patients with invasive bladder carcinoma underwent construction of detenial sigmoid neobladder after laparoscopic radical cystectomy in our hospital.After the bladder was excised by laparoscopy,a 5-to 7-cm incision was made on the abdomen to remove the resected tissues,and then a 15-to 20-cm sigmoid colon was resected,the two c...
出处 《中国微创外科杂志》 CSCD 2008年第4期289-291,共3页 Chinese Journal of Minimally Invasive Surgery
关键词 腹腔镜 膀胱切除术 膀胱肿瘤 尿路分流术 乙状结肠原位新膀胱术 Laparoscopy Cystectomy Bladder neoplasms Urinary diversion Construction of detenial sigmoid neobladder
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参考文献12

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