完全腹腔镜下根治性膀胱全切除加原位回肠新膀胱术(附3例报告)

Totally laparoscopic radical cystectomy with intracorporeal orthotopic ileal neobladder(Report of 3 cases)

目的:探讨完全腹腔镜下根治性膀胱全切除加原位回肠新膀胱术的临床可行性,并总结手术技巧。方法:对3例膀胱癌患者行腹腔镜下根治性膀胱全切术加扩大淋巴结清扫,并在腹腔镜下制备Studer新膀胱术。结果:3例手术均获成功,手术时间分别为510、470和450min,出血量300、150和210ml,淋巴结清扫数目为23、20(阳性1枚)和25枚,手术切缘阴性。术后第2天下地活动,第3天肠功能恢复,术后1个月行膀胱造影确定没有吻合口漏后拔除尿管和双侧输尿管支架管,无输尿管返流,肠漏和尿漏等并发症发生。术后住院时间分别为17、13和16天,术后随访分别为4、3和3个月,肾功能均正常,无复发或转移。结论:根据初期的手术操作过程和随访结果,完全腹腔镜下根治性膀胱全切除加原位回肠新膀胱术在临床上是可行的。更多的操作经验,长期和随机的对照研究将有助于对这一技术的评估和推广。

Objective：To investigate the clinical feasibility of totally laparoscopic radical cystectomy with intra- corporeal orthotopic ileal neobladder and to summarize the operative technique. Methods：The operative technique of totally laparoscopic radical cystectomy with extensive pelvic lymph node dissection and intracorporeal orthotopie il- eal neobladder with a Studer limb was performed in 3 patients. Results：All patients were completed totally laparo- scopic procedure as planned without any intraoperative complications or open conversion. Total operative time was 510, 470 and 450 min, respectively, with blood loss 300, 150 and 210ml. The number of removed lymph nodes was 23, 20（1 node positive） and 25, and surgical margins of the bladder specimen were negative in each case. All patients resumed ambulation on postoperative days 2, and bowel function were recovered on days 3. The il- eoureteral stents and the urethral catheter were removed at 1 month after a cystogram confirmed watertight heal- ing. No complications of ureteral reflux, urine and intestinal leaks occurred during the early postoperative period. Hospital stay was 17, 13 and 16 days, respectively. During follow up of 4, 3 and 3 months, renal function was normal in all 3 patients and no local or systemic progression. Conclusions： With the initial surgical experience and short-term follow-up, totally laparoscopic radical cystectomy with intracorporeal orthotopie ileal neobladder are feasible. More extensive experiences, longer-term and randomized trials will be required to better assess the appro- priateness and true potential of this technique.