腹腔镜下膀胱癌根治术36例报告

Laparoscopic radical cystectomy for bladder cancer(report of 36 cases)

目的探讨腹腔镜下全膀胱切除术治疗膀胱癌的手术方法和临床效果。方法36例患者，男性28例，女性8例；年龄56～75岁。36例病理证实为浸润性膀胱移行细胞癌Ⅱ～Ⅲ级，TNM分期：T2N2M0 22例，T3aN0M0 10例，T3bN0M0 4例。行腹腔镜下膀胱癌根治术，其中25例行原位乙状结肠代膀胱术，11例输尿管造口术，观察手术时间、术中出血量、术后肠道功能恢复、术后并发症及手术效果。站杲手术时间5～10h，术中失血200-1000mL，术后约72h肠道功能恢复，术后2周拔输尿管导管，术后3周拔尿管后腹压排尿正常，术后3个月IVU未见。肾积水，未出现腹腔并发症。结论腹腔镜下全膀胱切除术具有微创、出血少、恢复快等特点，随着技术的进步，该术式将成为治疗浸润性膀胱癌的较好方法之一。

Objective To evaluate the surgical technique and clinical efficacy of laparoscopic radical cystectomy for bladder cancer. Methods 28 males and 8 females aged 56-75 years（mean 67.5 years） with organ confined, muscle invasive transitional cell carcinoma of the bladder underwent surgery. The pathological reports of the 36 cases showed transitional cell carcinoma in Ⅱ-Ⅲ grades. 25 cases received laparoscopic radical cystectomy plus reconstruction of bladder with sigmoid, and 11 cases received ureterostomy. The operation time, the blood loss, the intestine function recovery time and the complication were observed. Results All operations were successful, with the operation time being 5-10 hours, the blood loss 200-1 000 mL, mean 360 mL. The intestine function recovered about 72hrs after operation. All ureteral catheters were removed 2 weeks after surgery. Urethral catheter was removed 3 weeks after surgery, and the patients were able to perform normosthenuria by abdominal pressure. The IVU was hormonal 3 months after surgery. Conclusion Laparoscopic radical cystectomy for invasive bladder cancer is a safe and efficient method , with advantages of good operating field, minimal invasion, less celiac complications, short hospital stay and rapid recovery. It is worth to be widespread.