腹腔镜下膀胱全切除原位乙状结肠代膀胱术(附12例报告)

Laparoscopic radical cystectomy with orthotopic ileal neobladder(report of 12 cases)

目的：探讨腹腔镜下膀胱全切除原位乙状结肠代膀胱手术的方法与治疗效果.方法：对12例浸润性膀胱癌患者采用腹腔镜下全膀胱切除术,前列腺切除或子宫次全切除.经腹壁造口取出切除物,行乙状结肠去带原位新膀胱术.结果：12例手术成功,手术时间5～10 h,平均6.5 h;出血量200～1 000 ml,平均387 ml,代膀胱充盈良好,容量约300 ml,术后4～6周患者恢复控尿功能,无排尿困难及尿失禁.结论：腹腔镜下行膀胱全切除视野清晰,可减少出血,缩短手术时间.

Objective： To present the initial experience and results of the laparoscopic radical cystectomy （LRC） with orthotopic ileal neobladder. Methods： Twelve patients （8 men and 4 women） with invasive bladder carcinoma were undergone LRC with orthotopic ileal neobladder. The mean age was 66 years （range, 56 to 70 years） . The procedure include radical cystectomy withprostate or uterus underwent with intracorporeal laparoscopic technique exclusively. Removal of the mobilized specimens and urinary diver- sion operation were managed via enlarged incision. The urinary diversion procedure includes： construction of the detenial sigmoid pouch, bilateral stented antiflux implantation of the ureter in the pouch and orthotopic anastomose of neobladder and urethra. Results： The mean duration of surgery was 5 to 10 h with a mean of 6.5 h; the blood loss was 200 to 1000 ml with a mean of 387 ml. During a follow up of 6 months,all patients were alive and asymptomatic with normal upper tracts and had no evidence of local recurrence or metastasis. 4 to 6 weeks after surgery, all the patients with orthotopic ileal bladder had complete daytime continence, and nocturnal continence was achieved with 2 to 3 times voiding at night. Conclusions. This procedure combines the advantages of minimally invasive laparoscopy with the speediness of open surgery. The laparoscopic cystoprostactomy has a magnified clear vision, which makes meticulous manipulation possible ,and reduces bleeding, sphincter injury and nerve bundle injury.