浸润性膀胱癌腹腔镜下根治性膀胱切除术43例

Laparoscopic radical cystectomy for 43 patients with invasive bladder carcinoma

目的探讨腹腔镜下根治性膀胱切除的手术方法和临床体会。方法自2003年12月至2006年10月我们对43例浸润性膀胱癌患者实施了腹腔镜根治性膀胱切除术。手术采用经腹腔入路5部位穿刺法。结果43例手术中，18例行输尿管皮肤造口术，25例行回肠膀胱术。2例因术中损伤直肠中转开腹行直肠修补术，1例术后放置肛管引流1周，另1例则行乙状结肠造瘘术。41例手术获得成功，腹腔镜下切除全膀胱连同淋巴结清扫的手术时间为140—270min，平均195．4min；术中出血150—700ml，平均273．7ml，术中术后输血3例；术后2—3d下床活动；术后病理示3例盆腔淋巴结阳性。结论腹腔镜根治性膀胱切除术治疗浸润性膀胱癌安全可行，能明显减小手术创伤、减少手术并发症、缩短患者恢复时间。

Objective To report initial experience with laparoscopic radical cystectomy in 43 patients with invasive bladder carcinoma. Methods From December 2003 to October 2006, 29 men and 14 women underwent laparoseopie radical eysteetomy with extraeorporeal-assisted urinary diversion for transitional cell carcinoma of the bladder （ n = 40） , adenoearcinoma （ n = 2 ） and squamous cell arcinoma （n = 1 ）. We report the specific technical details and present initial results of our series. Results The mean operative time of laparoseopie radical eysteetomy with pelvic lymph node dissection was 195.4 min, the mean blood loss 273.7 ml, and the transfusion rate 6.9%. Two procedures converted to open techniques. Lymphadeneetomy detected lymph node metastasis in three patients. Conclusions We demonstrate that the combination of laparoseopie radical eysteetomy and extraeorporeal urinary diversion is possible and remains a safe, feasible, and repeatable surgical technique. The laparoscopic surgery with extracorporeal urinary reconstruction is emerging as a viable alternative to open radical cysteetomy while characterized by less trauma, short recovery time and low complications. Intermediate oneologie outcomes are encouraging and comparable to those of open series. To determine the oneologie outcome long-time follow-up will be necessary.