腹腔镜下根治性膀胱切除回肠新膀胱术(附15例报告)

Laparoscopic radical cystectomy with orthotopic ileal neobladder(report of 15 cases)

目的介绍腹腔镜下根治性膀胱切除回肠新膀胱术的方法及经验。方法本组15例,均为男性,年龄45～62岁,平均54岁。术前均明确诊断为浸润性膀胱癌。采用腹腔镜下行膀胱癌根治性切除,然后取长约40 cm回肠于体外缝制贮尿囊及输尿管贮尿囊吻合,体内行贮尿囊尿道吻合术。结果手术时间5.5～8 h,平均6.5 h;出血量200～1100 ml,平均550 ml。术后8周静脉尿路造影以及代膀胱造影检查显示:双肾显影良好,无输尿管返流及梗阻,代膀胱充盈良好,容量约300 ml。术后3个月全部患者日间控尿良好,7例患者夜间控尿良好,夜间排尿2～3次。结论腹腔镜下膀胱全切除、体外建成贮尿囊及输尿管再植、体内贮尿囊尿道吻合术创伤小、出血少、术后尿控率高、恢复快。

Objective To present our initial experiences and results of the laparoseopic radical cystectomy （LRC）with orthotopie neobladder. Methods 15 male patients with pathological diagnosis of invasive bladder carcinoma underwent LRC with orthotopie ileal neobladder. The mean age was 54 years （ range 45 to 62 years） . The LRC with orthotopic neobladder was perform by laparoscopic eystectomy, extracorporeal ileal neobladder has been made by a 40-centimeter-long ileum and laparoseopic urethra-ileal neobladder anastomosis. Results The mean operative time was 6.5 hours （range 5. 5 to 8.0 hours） . The blood loss was 200 to 1100 ml with a mean of 550 ml. IVP and eystography showed no ureteral urine reflux during urination and the neobladder volume and compliance were normal. During a follow-up of 4 to 18 months, all patients were alive and asymptomatie with normal upper tracts and had no evidence of local recurrence or metastasis. 3 months after surgery, all the patients with orthotopic ileal bladder had complete daytime continence, and nocturnal conti- nence was achieved with 2 to 3 times voiding at night. Conclusions Laparoscopic radical- cysteetomy with orthotopic neobladder is feasible, although difficult and technically demanding. With growing experience, laparoscopie radical cystectomy and continent urinary diversion can be an alternative to the open technique.