腹腔镜全膀胱切除术临床分析(附10例报告)

Clinical analysis of laparoscopic radical cystectomy(Report of 10 cases)

目的:探讨腹腔镜下根治性全膀胱切除术的手术方法和临床体会。方法:我院于2008年7月～2010年12月对10例经病理证实为浸润性膀胱移行细胞癌患者行腹腔镜下根治性全膀胱切除术。其中男9例,女1例,年龄64～80岁,平均69岁。其中5例行原位回肠代膀胱术,5例行输尿管皮肤造口术,观察手术用时、术中出血量、术后肠道功能恢复时间、并发症及手术疗效。结果:手术用时170～290min,平均210min;术中出血150～950ml,平均250ml;术后肠道功能恢复约72h;术后未发生肠瘘及吻合口狭窄及尿瘘等严重并发症,无围手术期死亡,术后3个月IVU未见肾积水。结论:经腹腹腔镜全膀胱切除术安全可行,能明显减少手术创伤,术中出血少,术后恢复快、并发症少,随着器械的改进及技术熟练,该术式将成为全膀胱切除手术的一种很有前景的方法。

Objective：To introduce our experience and technique of laparoscopic radical cystectomy for invasive bladder carcinoma. Method： From July 2008 to December 2010, 9 male and 1 female underwent laparoscopic radical csctectomy, age ranged from 64 to 80, mean 69 years old. 5 cases were performed laparoscopic radical systectomy with orthotopic ileal neobladder, 5 cases were performed laparoscopic radical systectomy and ureterostomy. The operation time , the blood loss, the intestine function recovered time the complication and healing effect were retro- spectively reviewed. Result： All operations were successful with the operation time 170-290 min, mean 210 min. the blood loss 150-950 ml, mean 250 ml. The intestine function recovered about 72 h after operation. All ureteral catheters were removed 3 weeks after surgery, there were no coloreetal injuries, intestinal fistula and anastomosis stricture and fistula, severe complication such as perioperative death. The IVU showed no abnormality 3 months after 3 weeks after surgery. Conclusion： Laparoscopic radical cystectomy for invasive bladder cancer is safe and ef- fective, with andvantages of good operating field, less invasion, less complications, short hospital stay and rapid recovery. With the improvement of Equipment and the development of technology, the operation will become a promising approach for radical cystectomy.