腹腔镜下膀胱根治性切除术(附15例报告)

Laparoscopic radical cystectomy(a report of 15 cases)

目的探讨腹腔镜下膀胱根治性切除术的手术方法和临床效果。方法浸润性膀胱癌15例。采用5个Trocar,腹腔镜下行膀胱根治性切除术,下腹正中做5～7cm切口,取出切除的膀胱、前列腺。尿流改道方式包括6例通道式回肠膀胱术、2例乙状结肠代膀胱术、7例原位回肠膀胱术。结果手术时间250～480min,平均320min。术中出血200～800mL,平均420mL。平均每例清扫淋巴结数为16个,淋巴结阳性率13.3%,手术切缘均阴性。术后3、4d肠蠕动恢复,术后2、3周拔除单J管。1例术后出现麻痹性肠梗阻,2例术后出现淋巴漏,均保守治疗后痊愈。术后随访1～30个月,平均14个月,1例死于原发病转移,2例单侧上尿路轻度积水患者随访肾功能正常。1例回肠原位代膀胱患者夜间偶有尿失禁。结论腹腔镜膀胱癌根治术安全可行,创伤小,出血少,恢复快,但手术难度较大,手术技术要求较高。

[ Objective ] To study the technique and outcomes of laparoscopic radical cystectomy （LRC）. [Methods] A total of 15 patients with bladder cancer were enrolled in this study. LRC was performed with 5 trocars. A 5-7 cm middle abdominal incision was made, and the bladder and prostate were removed. Afterwards, the patients received urinary diversion surgery including ileal conduit urinary diversion in 6 cases, sigmoid colon orthotopic neobladder reconstruction in 2, ileal orthotopic neobladder reconstructioff in 7. [Results] The mean operation time was 320 minutes （ranged 250 to 480 rain） and mean blood loss was 420 mL （ranged 200 to 800 mL）. The average number of nodes of dissection was 16 with the positive nodes involvement of 13.3%. The surgical margin was negative in all the cases. The bowel movement recovery time was 3 to 4 days. The ureteral stents were removed in 2 to 3 weeks. After operation, 1 patient developed paralytic ileus and 2 patients had lymphatic fistula, and both were cured by conservative therapy. The patients were followed up for 1 to 30 months with a mean of 14 months, during which I died of distant metastasis, 2 developed unilateral slight hydrocele of upper urinary tract with normal renal function, 1 patient receiving ileal orthotopic neobladder reconstruction developed occasional urinary incontinence at night. [ Conclusions] LRC is a promising method for the treatment of bladder cancer. The procedure is complex and requires ad- vanced technique for operator.