经腹腔镜根治性全膀胱切除回肠原位代膀胱术18例

Laparoscopic radical cystectomy with orthotopic Ileal neobladder in 18 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18例均为膀胱尿路上皮癌，TNM分期为T2aN0M011例、T3aN0M05例、T3bN0M02例，麻醉选择气管插管全身麻醉，采用5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。结果全组18例均手术顺利，无一例中转行开放手术。手术时间为5～7．5（6．4±0．8）h；出血150～400（292．2±79．0）ml；术后肠道功能恢复时间为2～4d，2例出现漏尿，均在14d内消失。术后随访时间为6～12（9．4±1．8）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，3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治疗浸润性膀胱癌的一种有效的微创手术方法。

Objective To probe into the application value of laparoscopic radical cystectomy （LRC） with orthotopic ileal neoblad- der. Methods A total of 18 patients with invasive bladder carcinoma .underwent LRC with orthotopic ileal neobladder. Of the 18 patients, 11 were staged at T2aN0 M0, 5 at T3aN0M0 and 2 at T3bN0M0. Under the condition of intratraeheal intuhation and general anesthesia, laparoseope and clamps were placed in via 5 troears, and LRC with orthotopic ileal neobladder was performed. Results All the operations were successfully completed without conversion to open surgery. The mean duration of surgery was 5 - 7.5 hours with a mean of （6.4 ± 0.8） hours. The blood loss was 150 -400 ml with a mean of （292.2 ±79.0） ml. The function of howe1 recovered 2 -4 days after surgery. There were 2 cases of urinary leakage that disappeared within 14 days. All the patients a- chieved urine control, and had neither obstruction nor reflux proved by ultrasound 6 - 12 months, mean of （9.4 ± 1.8） months af- ter surgery. The residual urine of neobladder was more than 100 ml in 3 cases. There was no tumor recurrence and metastasis. Conclusion LRC with orthotopic ileal neohladder is feasible and effective for the patients with invasive bladder carcinoma.