腹腔镜根治性膀胱切除及回肠原位新膀胱术（附9例报告）

Laparoscopic radical cystectomy with orthotopic ileal neobladder：report of 9 cases

目的总结腹腔镜根治性膀胱切除加回肠原位新膀胱术的经验。方法对9例膀胱癌患者施行腹腔镜根治性膀胱切除及回肠原位新膀胱术，采用完全腹腔镜下标准的双侧盆腔淋巴结清扫加根治性膀胱切除，然后体外行回肠新膀胱构建和输尿管新膀胱吻合，最后在腹腔镜下行新膀胱尿道吻合。结果9例手术均成功，无中转开腹，无围手术期死亡，平均手术时间为370min，平均出血量为650ml，所有患者手术切缘均为阴性。术后9例日间尿控均良好，2例存在夜间尿失禁。术后随访2—8个月，1例出现新膀胱腹壁瘘，1例发生新膀胱前假性尿液囊肿，2例出现肾盂肾炎。结论腹腔镜根治性膀胱切除加回肠原位新膀胱术具有切口小、损伤少、疼痛轻、出血少、术后恢复快等优势，将成为肌层浸润性膀胱癌的标准手术方式。

Objective To summarize the experience and benefits of laparoscopic radical cystectomy with orthotopic ileal neobladder for bladder cancer. Methods 9 patients with bladder cancer underwent laparoscopic radical eystectomy with orthotopie ileal neobladder. The surgical procedure included standard laparoscopic pelvic lymphadenectomy, radical resection of bladder, extracorporeal formation of ileal pouch, extracorporeal implantation of ureters, and laparoscopic ure- thra- neobladder anastomosis. Results Laparoscopic radical cystectomy was successfully performed in 9 patients with orthotopic ileal neobladder. No operations were converted to open surery and there was no peri -operative mortality. The mean operation time was 370 rain and mean blood loss was 650 ml. No involvement of incisional edge was found in all the patients. Continence in all patients receiving neohladder was fully satisfactory during the day, 2 patients had urinary in- continence at night. The follow - up of 2 - 8 months showed complications including 1 fistula between neobladder and ab- dominal wall, 1 secondary urinoma anterior neobladde and 2 pyelonephritis. Conclusion Laparoscopie radical cysteeto- my has the advantage of being minimally invasive, decreased blood loss and postoperative pain, as well as a shorter hospi- tal stay and recovery. It will become a standard treatment of muscle - invasive bladder cancer.