腹腔镜下全膀胱切除术12例临床分析

Laparoscopic Radical Cystectomy of 12 Cases Carcinoma of Bladder

目的：介绍腹腔镜下全膀胱切除术的初步体会。方法：2006年1月至2008年12月治疗浸润性膀胱癌12例，男10例，女2例，年龄48～69岁，无远处转移。腹腔镜下行全膀胱切除、前列腺切除或子宫次全切。经腹壁造口取出切除物，行乙状结肠去带原位新膀胱术。结果：12例手术成功，腹腔镜下手术时间120～280min（平均180min）；开放原位新膀胱术190～300min（平均240min）。腹腔镜下操作出血量400～1000ml（平均600m1）；术中、术后输浓缩红细胞400～600ml（平均500m）。12例随访6～36个月，平均15个月。白天可控排尿10例（83．3％）轻度尿失禁2例（16．7％）。新膀胱容量180～320ml（平均270m1），尿间隔时间45～120min（平均80min）。1例勃起功能障碍（术前4例有勃起功能）。患者血Cr和Bun正常，未出现酸中毒。结论：腹腔镜下全膀胱切除术是可行和值得临床推广应用。

Objective ：To introduce the preliminary experience in laparoscopic total cystectomy. Method：From January 2006 to December 2008 ,We treated a total of 12 cases of distant metastasis -free invasive bladder cancer. There were 10 male and 2 female, 48 - 69 years old. These patients were performed prostatectomy or hysterectomy depending on the circumstances. Patients were performed laparoscopic radical cystectomy with reconstruction of bladder with sigmold . Result： All operations were successfully completed with the operation time of 120 -280min （mean 180 min）, with open orthotopic neobladder time 190 -300min （ mean 240 min ）, the blood loss 400 - 1000ml （ mean 600ml）. Intraoperative and postoperative, transfusion of red blood cell concentrates 400 - 600ml （mean 500ml）. 12 cases were followed up for 6 -36 months（ mean 15 ）. 10 cases voided smoothly during the day （83.3% ） , and 2 cases became mild incontinence （ 16. 7% ）. The new bladder capacity was 180 - 320ml （mean 270ml） , the time between urine was 45 - 120min （ mean 80min）. 1 case was erectile dysfunction after surgery （ Erectile function of 4 cases were normal ）. All patients Cr and Bun was normal. Acidosis does not appear. Conclusion：Laparoscopic radical cystectomy is feasible and worthy of clinical application