腹腔镜根治性膀胱切除及乙状结肠原位新膀胱术治疗18例浸润性膀胱癌:附视频

Experience of laparoscopic radical cystectomy and sigmoid colon orthotopic neobladder reconstruction for invasive bladder cancer: Report of 18 cases

目的总结腹腔镜根治性膀胱切除及乙状结肠原位新膀胱术治疗浸润性膀胱癌的治疗经验。方法回顾分析18例浸润性膀胱癌患者的临床资料,所有患者接受腹腔镜下盆腔淋巴结清扫、全膀胱及前列腺切除、经下腹部小切口取出切除组织并行去带乙状结肠原位新膀胱术。结果腹腔镜根治性膀胱切除术手术时间240～360min,出血量300～500ml;开放去带乙状结肠原位新膀胱术手术时间180～300min、出血量200～400ml。术后5～7d恢复饮食,2周后拔除盆腔引流管,3～4周拔除膀胱造瘘管,4～6周拔除导尿管及双侧输尿管支架管。结论腹腔镜根治性膀胱切除及乙状结肠原位新膀胱术创伤小、出血少、恢复快、疗效确切、并发症少,是浸润性膀胱癌较好的一种治疗方法,具有较好的临床应用价值。

Objective To summarize the experience of laparoscopic radical cystectomy and sigmoid colon orthotopie neobladder reconstruction for invasive bladder cancer. Methods The clinical data of 18 patients with invasive bladder cancer were analyzed retrospectively. These patients underwent prostatectomy or hysterectomy depending on the gender. Radical cystectomies and pelvic lymphadenectomies were performed with laparoscopic technique. The resected specimens were removed via enlarged incision and the detenial sigmoid neobladder was reconstructed. Results All operations were completed successfully. Laparoscopic operation time was 240 to 360 minutes and blood lost was 300 to 500 ml. Open neobladder reconstruction time was 180 to 300 minutes and blood lost was 200 to 400 ml. Oral intake was allowed in 5 to 7 days after operation. Pelvic drainages were removed in 2 weeks and bladder fistula was removed in 3 to 4 weeks. Bilateral urteral stents and the pouch catheter were removed in 4 to 6 weeks postoperatively. Conclusions Laparoscopic radical eysteetomy and sigmoid colon orthotopie neobladder reconstruction takes advantages in less trauma, faster recovery, better therapeutic effects and less complications. It is a safe and effective surgical method for invasive bladder cancer.