腹腔镜下全膀胱切除原位回肠新膀胱术(5例报告)

Laparoscopic assisted radical cystectomy with ileal neobladder in 5 cases of invasive transitional cell cancer of bladder

目的探讨在基层医院采用腹腔镜下全膀胱切除原位回肠新膀胱术的临床应用。方法浸润性膀胱癌患者5例,年龄60～65岁,男3例,女2例。采用OLYMPUS腹腔镜根治性切除膀胱后通过腹壁小切口形成回肠新膀胱,然后在腹腔镜下将新膀胱与尿道吻合。结果 5例患者手术均成功。手术平均时间8 h,出血量平均280 ml。术后2周拔除输尿管支架管,术后3周拔除导尿管。术后随访时间5～19个月,除1例女性患者外均能控制排尿,肾功能电解质大致在正常范围,未见肿瘤复发及远处转移。结论腹腔镜下全膀胱切除原位回肠新膀胱术使传统的膀胱癌根治手术实现微创化,术中出血少,术后恢复快,在基层医院开展已成为可能。

Objective To report initial experience of laparoscopic assisted radical cystectomy with ileal neobladder in 5 cases of invasive bladder cancer. Methods 5 cases with muscle invasive bladder cancer aged from 60 to 65, 3 male and 2 female, underwent laparoscopic assisted radical cystectomy with ileal neobladder. Results patients had successful operations, the mean operating time was 8 h and blood loss was 280 ml. The ureteral stents and urethral catheter were removed in 2 and 3 weeks sequentially after the surgery. Fellow-up from 5-19 month in these 5 cases denmonstrated that the continency recovered well except one female, and biochemical parameters kept in normal limit. No tumor recurrence or metastasis is found. Conclusions With the help of profound training in urological laparoscope, the learning curve can be shortened for those skilled at open surgery in chanllenging urological laparoscopic operations.