腹腔镜根治性全膀胱切除回肠新膀胱术治疗浸润性膀胱癌（附30例报告）

Laparoscopic radical cystectomy（LRC） with orthotopic ileal neobladder for invasive bladder cancer（report of 30 cases）

目的 探讨腹腔镜下根治性全膀胱切除原位回肠新膀胱术的手术方法及临床疗效.方法 收集2007年5月至2011年10月应用腹腔镜下根治性全膀胱切除原位回肠新膀胱术的浸润性膀胱癌患者30例.对其临床资料进行回顾性分析和总结.结果 所有手术均获得成功,无中转开放,手术时间180～360 min（平均240 min）,术中出血量150～450mL（平均220 mL）.术后4～8d恢复肠道正常蠕动功能,随访时间6～60个月,中位随访时间26个月.30例术后均能恢复较满意的控尿功能,平均膀胱容量约398mL,平均夜尿1～3次；1例出现夜间遗尿；2例出现尿漏；膀胱镜检查无尿道肿瘤复发；2例死于原发病转移.其余患者术后随访6个月血生化指标均正常,B超检查未见上尿路扩张积水.结论 腹腔镜下根治性全膀胱切除原位回肠新膀胱术具有创伤小、出血少、盆腔淋巴结清扫彻底、术后恢复快、术后控尿满意等优点,是治疗浸润性膀胱癌的一种理想手术方式.

Objectives To present the surgical methods and the clinical efficacy of the laparoscopic radical cystectomy （LRC） with orthotopic ileal neobladder. Methods The clinical data of 30 cases of patients underwent laparoscopic radical cystectomy （LRC） with orthotopic ileal neobladder were analysed retrospectively and summarized between May, 2007 and Oct, 2011. Results All the operations were successfully completed without conversion to open surgery. The operation time is 180 - 360min with a mean of 240min. The intraoperative bleeding is 150 - 450 ml with a mean of 220 ml. The bowel recovery time was 4 - 8 days. The followed up time were from 6 to 60 mouths, median follow - up time was 26 mouths. 30 cases achieved urine control function with satisfaction, the mean value of neobladder maximum capacity were 398 ml and the night - time urination were 1 - 3 times. 1 case occurred nocturnal enuresis and 2 cases occurred urinary leak. Cystoscopy were not found the cancer recurrence in urethra. 2 cases died of metastasis of the primary disease and the blood biochemical examination of other patients were essentially normal with following up for 6 months, B - ultrasonic examination were not found the dilation or seeper in bilateral upper uri- nary tract. Conclusions Laparoscopic radical cystectomy （LRC） with orthotopicileal neobladder was a ideal op- eration method treatment of invasive bladder cancer（IBC）. As its had the advantage of fewer traumas, less bleeding, complete pelvic lymph node dissection, rapider recovery and produced a higher rate of urinary continence.