改良腹腔镜根治性膀胱切除术加Studer原位回肠新膀胱重建初步研究

Pilot study of modified laparoscopic radical cystectomy and construction of orthotopic studer ileal neobladder

目的:总结11例腹腔镜根治性膀胱切除、标准淋巴结清扫加Studer原位回肠新膀胱重建的经验,评价此术式肿瘤学结果与功能性结果。方法:2008年7月～2011年5月,选择11例肌层浸润性膀胱肿瘤患者实施腹腔镜根治性膀胱切除加下腹壁小切口行Studer原位回肠新膀胱重建术,对手术时间、淋巴结数量、围手术期并发症、出血量、输血量、生存率、上尿路形态与功能、控尿情况进行分析。结果:平均手术时间为6.17(5.5～7.5)h,平均出血量为300(0～800)ml,仅1例输血400ml,平均清扫淋巴结数15(5～30)个,无围手术期死亡,围手术期并发症发生率为18.19%(2/11)。上尿路检查,提示18.19%(2/11)术后拔出双J管后出现双侧肾盂及输尿管的轻度暂时性扩张,其中1例血肌酐上升。随访15(1～67)个月,1例鳞癌死于广泛转移,91%(10/11)无复发生存。患者日间完全控尿率达到90%(9/10);夜间完全控尿率70%(7/10),小于1块尿垫20%(2/10)。结论:选择适当病例行改良的腹腔镜根治性膀胱切除、标准淋巴结清扫加下腹壁小切口行Studer原位回肠新膀胱重建术取得了满意肿瘤学与功能性结果;Studer原位回肠新膀胱顺向蠕动输入袢能够保护上尿路形态与功能。

Objective：To summarize the initial experience of 11 cases of modified laparoscopic radical cystecto- my and construction of orthotopie Studer ileal neobladder,and the oncological and functional results of this proce- dure. Method：From July 2008 through May 2011,11 selected patients underwent modified radical eystectomy and standard lymphadeneetomy followed by construction of orthotopic Studer ileal neobladder by mini-taparostomy for muscle invasive bladder cancer. Data were analyzed according to procedure time,blood loss, transfusion, number of dissected lymph nodes,peri-operative complications,morphology and function of upper urinary tract, and status of urinary continence. Result： Mean operating time was 6.17 （5.5 -- 7.5 ） h, estimated blood loss 300 （0 -- 800） ml, on- ly one case need transfusion 400 ml,lymph nodes dissected 15（5--30）, no peri-operative death, peri-operative com- plications was found in 18.9 % （2/11）. Temporary dilation of upper urinary tract was observed in 18 % （2/11）in 45 days post-operative, then disappeared spontaneously, Serum creatinine remained in normal range in all patients. With 15 （1 -- 67） months follow-up, 1 case died of metastasis of squamous cell carcinoma. 91% （ 10/11 ） survived without local relapse or distal metastasis. Complete daytime continence rate was 90% （9/10） ;complete night-time continence rate 70~ （7/10）and 1 pad in 20% （2/10）. Conclusion：The oncological and functional results are encour- aging after modified laparoscopic radical cystectomy and construction of orthotopic Studer ileal neobladder;The af- ferent tubular segment of neobladder is effective to protect the morphology and function of upper urinary tract.