手助腹腔镜根治性膀胱切除术(附31例报告)

Hand-assisted laparoscopic radical cystectomy(report of 31 cases)

目的探讨手助腹腔镜根治性膀胱切除术的临床应用价值。方法采用手助腹腔镜行根治性膀胱切除术31例,其中利用手助操作通道的切口行回肠膀胱术24例,原位回肠新膀胱术7例;并观察围手术期的恢复情况及近期疗效。结果31例手助腹腔镜下根治性膀胱切除均获成功,手术时间245～530 min,平均365.7 min;出血量100～500 ml,平均250.9 ml。其中3例需输血,输血率为9.7%。术后进食时间为2～15 d,平均4.3 d。住院时间平均19.7 d(9～83 d)。术后6例发生围手术期并发症,占19.4%。31例患者均获随访,平均18个月(1～38个月),2例回肠膀胱切口疝,1例输尿管新膀胱吻合口狭窄。肺部转移及局部复发并全身转移各1例,带瘤生存。肿瘤转移死亡1例,猝死1例。其余27例无瘤存活。结论手助腹腔镜根治性膀胱切除术是安全、可行的,尤其在复杂的根治性膀胱切除术中可以减少手术出血,降低手术难度,有效防止并发症的发生。

Objective To present our experience with hand-assisted laparoscopic radical cystectomy and extracorporeal urinary diversion for bladder cancer. Methods Between May 2004 and November 2007,31 patients （mean age 61.3 years, range 40-79） underwent hand-assisted laparoscopic radical cystectomy for bladder cancer with extracorporeal urinary pouch reconstruction. Five patients had previously undergone abdominal surgeries. Data were collected with respect to patient demographics, perioperative outcomes and short-term oncological follow up. Results Twenty-four patients underwent ileal conduit diversion and 7 orthotopic neobladder. Mean operative time was 365.7 min （range 245 to 530）. Estimated blood loss was 250. 9 ml （range 100 to 500）,with a transfusion rate of 9.7%. Oral liquids were resumed at 4. 3 days and the mean hospital stay was 19. 7 days. There were no intraoperative complications. Postoperative early complications （within 30 days of surgery） were noted in 6 patients （19. 40%）. 2 wound infections, 1 urinary leakage, 1 wound dehiscence, 1 bowel obstruction and 1 alimentary tract hemorrhage, all were treated conservatively. Late complications were noted in 3 patients （2 parastomal hernias and 1 ureteroenteral stricture）. With a mean follow up of 18 months, 27 patients had no evidence of disease. One patient died because of cancer and one died for unrelated causes. One was alive with local recurrences and one with lung metastasis. Conclusions Hand-assisted laparoscopic radical cystectomy is a safe, reproducible and minimally invasive option for bladder cancer patients.