腹腔镜下根治性膀胱切除原位回肠代膀胱术治疗浸润性膀胱癌

Laparoscopic radical cystectomy with orthotopic ileal neobladder in the treatment of invasive bladdercancer

目的探讨应用腹腔镜下根治性膀胱切除原位回肠代膀胱术治疗浸润性膀胱癌患者的手术方法和临床疗效。方法回顾性分析2005年2月至2010年6月，采用腹腔镜下根治性膀胱切除原位回肠代膀胱术治疗的11例膀胱癌患者的临床资料，评价手术治疗效果、尿动力学检查结果、上尿路功能以及并发症。结果11例膀胱癌患者手术时间为350-490min，平均420．4min。术中出血量为300-700ml，平均410．2ml。11例患者中，有10例患者白天完全能控制排尿，白天尿失禁者1例；夜间轻度尿失禁者3例，排尿困难2例。尿流率为（11．5±2．0）ml/s，膀胱初始感觉充盈压为（29．3±3．0）cm H2O，最大充盈压为（36．0±4．1）cm H2O，膀胱初始感觉和最大充盈压其相应储尿囊容量分别为（162．4±23．5）ml和（410．0±36．2）ml，后尿道闭合压力为（49．1±3．0）cmH20。残余尿量0-35ml，平均残余尿量20．2ml。功能性尿道长度3．2-4．2cm，平均功能性尿道长度3．7cm。结论腹腔镜下根治性膀胱切除原位回肠代膀胱术安全可行，回肠新膀胱具有储尿囊内压低、容量大、可控性和原位排尿的特点，是一种较理想的尿流改道方式。

Objective To study the technique and outcomes of laparoscopic radical cystectomy （LRC） and evaluate the efficacy of the urinary reservoir constructed with ileum in patients with invasive bladder cancer. Methods From 2005-2010, A total of 11 patients with bladder cancer were enrolled in this study. Laparoscopy was performed with 5 trocars. Urodynamic examination was performed, the function of upper urinary tract was tested, and complications were evaluated in all the eleven cases. Results The mean operation time was 420 minutes （ranged 350 to 490 rain） and mean blood loss was 410 ml （ranged 300 to 700 ml）. Ten of the 11 patients had complete continence, and one case had incontinence. The average flow rate was 11.5 ml/s. The first pressure of the reservoir was 29 cm H2 O, and the maximum pressure was 36 cm H2O. The average capacity was 162 ml and 410 ml, respectively. The outlet pressure was 49 cm H2O. The volume of residual urine was 0-35 ml. No evidence of ureteral reflux was noted. Conclusions Laparoscopic radical cysteetomy is a promising method for the treatment of bladder cancer. Orthotopic ileal neobladder is considered as an ideal form of urinary diversion characterized with low pressure, larger capacity and continence.