腹腔镜根治性膀胱切除术及直肠代膀胱术的临床疗效分析(附37例报告)

Laparoscopic Radical Cyctectomy and Rectum Pouch for Urinary Diversion( Report of 37 Cases)

目的 探讨腹腔镜根治性膀胱切除术及直肠代膀胱术的手术方法和临床疗效。方法 收集本单位2011年10月至2014年6月采用腹腔镜根治性膀胱切除术及直肠代膀胱术的37例膀胱癌患者的临床资料,观察手术时间、术中出血量、术后肠道功能恢复、住院时间、术后并发症及手术效果,并进行统计分析。结果 37例患者的手术均成功完成。手术时间(230±55)分钟,术中出血量(320±110)ml,术后肠蠕动恢复时间为(4±2)天,术后拔除引流管时间为(7±2)天,术后拔除输尿管支架管时间为(13±3)天,术后住院天数为(18±3)天。1例患者术后2月出现粘连性肠梗阻,其余均未出现感染、肠瘘和术后出血等严重手术并发症。术后随访2~36个月,1例死于原发病转移,余患者未见肿瘤复发或远处转移。术后患者排尿通畅,未出现排尿困难;直肠膀胱功能正常,肾功能正常。结论 腹腔镜根治性膀胱切除术及直肠代膀胱术创伤小、出血少、恢复快,但操作难度大,是治疗浸润性膀胱癌的一种有效方法。

Objective To evaluate the surgical technique and clinical efficacy of laparoscopic radical cystec-tomy and rectum pouch for urinary diversion. Methods From October 2011 to June 2014,37 patients with inva-sive bladder cancer were treated with laparoscopic radical cystectomy and rectum pouch for urinary diversion. The operation time,the blood loss,the intestine function recovery time and the complication were observed. Re-sults All operations were successful,with the operation time being (230 ± 55)minutes,the blood loss (320 ± 110)ml. Recovery of bowel movement occurred (4 ± 2)days after surgery and the postoperative hospital stay was (18 ± 3)days. No severe intraoperative and postoperative complications,such as intestinal fistula and hem-orrhage,occurred,except that one patient suffered adhesive intestinal obstruction. After 2~36 months of follow-up,there was no case of recurrence and metastasis,except 1 case died of primary disease metastasis. All pa-tients urinated normally and the function of rectum pouch was regular. Conclusions Laparoscopic radical cyctec-tomy and rectum pouch for urinary diversion is a safe,effective and feasible but technically challenging alterna-tive for invasive bladder cancer.