全膀胱切除、去带乙状结肠新膀胱术后近期并发症分析

The early complications after radical cystectomy and continent complete detenial sigmoid colon neobladder in 148 cases

目的:总结我们148例膀胱癌全膀胱切除、去带乙状结肠新膀胱术后近期(≤3个月)并发症发生情况。方法:2000年2月至2008年8月间浸润性膀胱癌患者148例,男122例,女26例。年龄1.5～86岁。开放手术完成全膀胱切除47例;术中采用腹腔镜行膀胱全切除术101例,其中26例关闭腹壁后腹腔镜下行贮尿囊与后尿道吻合。采用去带乙状结肠制备贮尿囊,充分剔除结肠带并横断结肠带间肌层。结果:148例术后近期总并发症发生率16.22%,其中出血1例;贮尿囊尿道吻合口延迟愈合6例;肠瘘5例;持续腹泻1例;重症感染死亡2例;吻合口闭锁1例;吻合口狭窄6例;黏液栓堵塞1例。结论:原位新膀胱术不仅步骤较多、手术难度大,术后并发症发生率也较高。腹腔镜技术在膀胱全切及尿流重建术中的应用,降低了术后并发症的发生率。

Objictive To estimate the early complications after radical cystectomy and continent complete detenial sigmoid colon neobladder in 148 cases. Methods There were 148 patients （122 males and 26 females, aged 1.5 to 86 years old） with invasive carcinoma of bladder underwent surgery from Feb 2000 to Aug 2008. 47 patients received radical cystectomy by open operation and 101 patients by laparoscopic technique, among whom 26 patients received anastomosed neobladder and urethra under laparoscopy. The neobladder was made by detenial sigmoid colon. Results The overall incidence of early complications were 16.22%, among them 1 ease was hemorrhage, 6 cases had delayed cieatrisation of the anastomosis, 5 eases were intestines fistula, 2 cases had diarrhea, 2 cases died of severe infection, 1 case had anastomosis atresia, 6 cases had anastomosis stricture, and 1 case had mucus jammed the urethra. Conclusions The radical cystectomy and neobladder is not only a difficult operation but also has many complications. The early complications can be reduced by laparoscopic technique.