腹腔镜下膀胱肿瘤根治性切除术初步报告

目的探讨腹腔镜下膀胱肿瘤根治性切除术—尿流改道术的手术方法及其优越性。方法自2005年2月至今共为3例浸润性膀胱癌患者施行了腹腔镜下膀胱肿瘤根治性切除术。男2例、女1例，年龄54～72岁，平均年龄64．8岁；1例行bricker术，2例行原位回肠新膀胱术。结果平均手术时间分别为450min（360～540min），其中腹腔镜下平均操作时间为240min（190—320min），平均出血量620ml（450—900ml），术后无尿漏、出血，肠梗阻等并发症，术后10d左右出院，1例患者术后1个月出现新膀胱阴道瘘。术后2个月复查IVU均无上尿路积水情况。结论腹腔镜下膀胱肿瘤根治性切除术视野清楚，对深部血管，神经的处理更加精细，可以有效避免尿道括约肌，血管神经束的损伤，术中出血减少；对于行原位新膀胱手术的患者，术后生活质量明显提高。

Objective Radical cystectomy is the standard of care for patients with muscle invasive bladder cancer,While open radical cystectomy is now a standard procedure, laparoscopic radical cystectomy is still in its infancy. We perfurmed this surgery laparoscopically in 3 patients and review the procedure specific complications,Methods Beginning in February 2005, 3 patients underwent laparoscopic radical cystectomy New Dehli. Urinary diversion was performed by an open-hand sewn ileal conduit, Results There were three intraoperative complications specifically related to the laparoscopic radical cystectomy. These included injury to the external lilac vein in one patient and a small rectal tear in two, All were repaired with laparoscopic free hand suturing with normal postoperative recovery,Other laparoscopy-related complications were subcutaneous emphysema in one patient and hypercarbia necessitating conversion to open surgery in a patient who, four weeks after surgery, died of multiple organ failure, One patient had margins positive and received cisplatinum-based chemotherapy. All patients had normal renal function and preserved upper tracts with no evidence of metastasis at a mean of 18,4 months follow up （range 1-48 months）.Conelusion Though there were three complications specific to the laparoscopic radical cystectomy,none necessitated a conversion to open surgery or hampered the overall outcome, Absence of local recurrence or metastatic disease at four years of follow up suggests that the procedure is oncologically valid. Laparoscopic radical cystectomy is a new procedure and it is important to critically analyze the complications in order to reduce their occurrence and allow the development of a better technique,