腹腔镜下根治性膀胱切除-原位回肠新膀胱重建治疗浸润性膀胱癌效果观察

Laparoscopic radical cystectomy and orthotopic ileal neobladder reconstruction

目的总结我院应用腹腔镜下根治性膀胱切除及回肠原位新膀胱术的初步经验。方法采用腹腔镜下根治性膀胱切除与回肠原位新膀胱重建治疗浸润性膀胱癌患者8例。腹腔镜手术中以超声刀及双极电凝行膀胱侧韧带、前列腺血管蒂及前列腺尖部切断止血,经腹壁小切口取出切除物,行回肠去管成形新膀胱,然后在腹腔镜下将新膀胱与尿道吻合。结果 8例患者手术成功,手术时间5～7小时;术中出血量约200～650 ml,其中2例输血400 ml;术后3～4天恢复饮食,2周拔除输尿管支架管,3～4周拔除导尿管;患者白天可基本控制排尿,2例夜间有尿失禁,3月后基本恢复控尿;2例术后尿漏,经引流两周左右治愈。结论腹腔镜下全膀胱切除术及原位新膀胱术具有创伤小、出血少、恢复快、较好的新膀胱功能等优点;回肠新膀胱和尿道吻合具有操作方便、缝合紧密等优点,可积极推广。

Objective To report our techniques and experience with Laparoscopic radical cystectomy(LRC) and orthotopic ileal neobladder for bladder cancer.Methods 8 patients underwent LRC and orthotopic ileal neobladder for bladder cancer.Data were collected with respect to patient demographics,perioperative outcomes and short-term oncological follow up.Results The operative time ranged from 5 to 7 hours.The blood loss was 200~650 ml.Blood transfusion of two patients was 400 ml respectively.The intestine function recovered about 3~4 days after operation.The stents were usually removed on the 14 postoperative days,and the urethral catheter was removed on the 21~28 postoperative days.Eight patients with orthotopic ileal neobladder had complete daytime continence,two patients had urinary incontinence at night.Two patients with urinary fistula healed at two weeks.Conclusion Laparoscopic radical cystectomy and orthotopic neobladder is a safe,reproducible and minimally invasive option for bladder cancer patients.