腹腔镜全膀胱根治性切除术治疗膀胱癌(附4例报告)

Laparoscopic Radical Cystectomy for Carcinoma of Bladder (Report of 4 Cases)

目的:探讨腹腔镜全膀胱根治术的手术方法及其临床效果。方法:均采用气管插管麻醉。腹腔镜下切除膀胱和前列腺。结果:手术时间为256～476分钟,平均为368分钟;术中出血量为100～400ml,平均为248ml。肠道恢复时间为术后1～3天,平均为1.5天。术后2～4天开始进食。手术后8～13天痊愈出院。手术后病理报告:4例均为膀胱移行细胞癌Ⅱ～Ⅲ级,其中3例浸润浅肌层。手术中和手术后均未发生并发症。手术后随访6～9个月,一般状况良好,无肿瘤复发及转移。结论:腹腔镜全膀胱根治术具有创伤小、解剖清晰、术中出血少和术后恢复快等优点,是一种安全、有效的治疗方法。

Objective： To investigate the surgical technique and clinical effectiveness of Laparoscopic radical eystectomy. Methods： The method of tracheal-intubation anaesthesia was used. After general anaesthesia, prostrate position was posed and buttocks were raised in all the patients. The needles were inserted to create the pneumoperitoneum and the pressure at 12 to 15mmHg kept. The 10mm-Trocar-sheath units were punctured into the peritoneal cavity above the umbilicus. Results： The operating time was 256 to 476 minutes, （average 368 min）, blood loss was 100 to 400ml （average 248 ml）. Oral intake started on hospital day 1 to 3 （average 1.5 days）. Food-intake recovered at clay 2 to 4 after operation and the patients were discharged from hospital about 8 to 13 days after operation. Histopathological examination of the specimens revealed transitional cell carcinoma grade Ⅱ-Ⅲ, stage T2a 3 cases. No intraoperative or postoperative complications were observed. Follow-up 6 to 9 months after operation without the recurrence and metastasis. Conclusion： With more experiment and improve- ment of the surgical technique, the laparoscopic radical cystectomy boasts with minimum incision, limpid dissection, less intraoperative bleeding and rapid recovery, and is the safe and effective method for patients with localized muscle invasive bladder neoplasm.