腹腔镜下全膀胱切除加原位回肠代膀胱术的临床疗效——附12例报告

Experiences in laparoscopic radical total cystectomy plus reconstruction of bladder with ileum(Report of 12 cases)

目的：探讨腹腔镜下全膀胱切除加原位回肠代膀胱术的手术方法和临床效果。方法：对12例浸润性膀胱移行细胞癌Ⅱ～Ⅲ级患者行腹腔镜下全膀胱切除加原位回肠代膀胱术,观察手术时间、术中出血量、术后肠道功能恢复情况及术后并发症等于术效果。结果：手术时间7～10h,术中失血600～1500ml,术后约72h恢复肠道功能。术后2周拔除输尿管导管,术后3周拔尿管后腹压排尿正常,术后3个月IVU复查未见肾积水,未出现并发症。结论：该术式具有微创、出血少、恢复快等特点,将成为治疗浸润性膀胱癌的较好方法之一。

Objective：To evaluate the surgical technique and clinical efficacy of laparoscopic radical total cystectomy plus reconstruction of bladder with ileum for bladder cancer. Methods： We analysed 12 cases of bladder cancer,with age from 58 to 73 years （mean 68.5 years） ,pathological reports were transitional cell carcinoma Ⅱ～Ⅲ grads,2 cases were squamous carcinoma. We perform laparoscopic radical total cystectomy plus reconstruction of bladder with ileum, watched the operation time. the blood loss. the intestine function and the complication. Results： All operation were successful, the operation time was 7 - 10 hours, the blood loss was 600- 1 500 ml, mean 850ml, the intestine function recovered about 72 hours after operation,all ureteral catheter were removed at 2 weeks after surgery, urethral catheters were removed at 3 weeks after surgery and normosthenuria by abdominal pressure, the IVU were normonal. Conclusions： Laparoscopic radical total cystectomy plus reconstruction of bladder with ileum for invasive bladder cancer is a safe, efficient method, with advantages of good operating field, reliable hemostasis, mini-invasion, less celiac complications, hospital stay and rapid recovery, worth to be extended.