完全腹腔镜下根治性膀胱切除原位回肠新膀胱术:附15例报告

Pure laparoscopic radical cystectomy with orthotopic ileal neobladder: Report of 15 cases

目的探讨腹腔镜下根治性膀胱切除原位回肠新膀胱术的临床可行性，并总结手术技巧。方法对15例膀胱癌患者行腹腔镜下根治性膀胱切除术，并在腹腔镜下施行原位回肠新膀胱术。结果15例手术时间为341±47．3（275～440）min，出血量740±336（300—1400）ml，术后病理证实均为膀胱尿路上皮癌，淋巴结清扫数目为16±4．4（10～27）枚，手术切缘均为阴性。术后3．8±0．9（3～6）d肠功能恢复，术后2周拔除单J管，1例出现吻合口肠瘘，其余无并发症发生，术后住院时间25±4．1（21～33）d。术后随访6～15个月，无复发或转移病例。结论完全腹腔镜下根治性膀胱切除及原位回肠新膀胱术进一步减少手术创伤，解剖结构显露较满意，有利于患者术后恢复。但由于手术难度较大，术者须熟练掌握各种腹腔镜操作技术后方可开展。

Objective To investigate the clinical feasibility of pure laparoscopic radical cystectomy with orthotopic ileal neobladder and summarize the surgical techniques. Methods Fifteen patients with bladder cancer underwent laparoscopic radical cystectomy with orthotopic ileal neobladder. Results Operation time was 341±47.3（275-440） minutes and the blood loss was 740＋336（300-1400） ml. Postoperative pathologic results confirmed that all patients had bladder transitional cell carcinoma. The number of lymph nodes was 16±4.4（10-27）. No positive surgical margin was found in all patients. The recovery time of intestinal function was 3.8±0.9（3-6） days. The single-J catheters were removed two weeks after operation. No severe complication occurred except for one case of intestinal fistula. The postoperative hospitalization time was 25±4.1 （21-33） days. Patients were followed up for 6-15 months, within which no recurrence or metastasis was found. Conclusions Pure laparoscopic radical cystectomy with orthotopic ileal neobladder can reduce surgical trauma, expose the anatomical structure more clearly and help patients postoperative recovery. Due to the difficulty of the surgical procedures, the surgeon must have mastered laparoscopic technique.