经腹腔镜根治性全膀胱切除回肠原位代膀胱术11例

Laparoscopic radical cystectomy with orthotopic ileal neobladder (report of 11 cases)

目的探讨腹腔镜技术在根治性全膀胱切除回肠原位代膀胱术中的应用价值。方法本组11例均为膀胱尿路上皮癌,TNM分期为T2aN0M07例、T3aN0M03例、T3bN0M01例,麻醉选择气管插管全身麻醉,采用五点穿刺法置入腹腔镜,手术方式为根治性全膀胱切除回肠原位代膀胱术。结果本组11例均手术顺利,无一例中转开放。手术时间为5～8h,平均7h;出血150～450ml,平均350ml。术后肠道功能恢复时间为2～5d,2例出现漏尿,均在14d内消失。术后随访时间为6～12个月,平均10个月。所有病例控尿情况均较理想,超声检查均未发现输尿管扩张、肾积水,2例代膀胱残余尿>100ml,均未发现复发及转移。结论根治性全膀胱切除回肠原位代膀胱术是膀胱癌治疗的一种有效方法。目前膀胱癌根治性切除术有开放性手术和经腹腔镜手术两种,与开放性手术比较,经腹腔镜手术虽具有诸多优势,但仍有必要对一些热点问题进行探讨,寻找更为合理的手术步骤、技巧和方法,从而进一步推动该项技术的发展。

Objective To explore the application value of laparoscopic radical cystectomy （LRC） with orthotopic ileal neobladder. Methods 11 patients with invasive bladder carcinoma un- derwent laparoscopic radical cysteetomy with orthotopic ileal neobladder. 7 cases of T2aN0 M0, 3 ca- ses of T3,N0 M0, 1 case of T3hN0 M0, intubated on general anesthesia. Laparoscopic and clamps were placed in with 5 trocars, Results All the operations were successfully completed without conver- sion to open surgery. The mean duration of surgery was 5 to 8 h with a mean of 7 h. The blood loss was 150 to 450 ml with a mean of 350 ml. The function of bowel recovered 2 to 5 d after surgery. There were 2 cases of urinary leakage that disappeared within 14 d. All of patients achieved urine control and had neither obstruction nor reflux proved by the ultrasound 6 to 12 months with a mean of 10 months after surgery. The residual urine of neobladder of 2 cases was more than 100 ml. There was no tumor recurring and metastasis. Conclusions The LRC with orthotopic ileal neobladder is feasible and effective for the patients with invasive bladder carcinoma.