腹腔镜无管化兔头回肠原位新膀胱治疗浸润性膀胱癌:附视频

Laparoscopic radical cystectomy with tubeless orthotopic ileal neobladder in the treatment of muscle-invasive bladder cancer

目的探索腹腔镜膀胱根治性切除及无管化兔头回肠原位新膀胱术治疗浸润性膀胱癌的初步经验。方法回顾分析2012年3月至2012年12月采用腹腔镜治疗浸润性膀胱癌3例,3例患者年龄分别为57、65及76岁。取回肠50 cm,中部40 cm剖开缝成"W形"新膀胱,两端各保留5 cm肠管形似兔耳与新膀胱体呈兔头形状,两侧兔耳部分别植入两侧输尿管,术中双侧输尿管内未留置双J管或外支架管,回肠新膀胱无留置造瘘管,新膀胱底部与后尿道断端吻合,仅在新膀胱内留置双腔尿管。初步观察手术时间、并发症、住院日数等。结果手术时间为分别为380、402及430 min,1例术后肠粘连,对症治疗后好转。无伤口感染、尿漏及其他并发症。结论腹腔镜无管化兔头回肠原位新膀胱术治疗经选择的浸润性膀胱癌是可行的。

Objective To explore the experiences of laparoscopic radical cystectomy with tubeless rabbit-type orthotopic ileal neobladder in the treatment of muscle-invasive bladder cancer. Methods Between March 2012 and December 2012, three male patients with muscle-invasive bladder cancer underwent laparoscopic cystectomy. In all three cases, the patients were 57, 65 and 76 years old. Fifties cm-long terminal ileal segment was harvested. The medial 40 cm of the ileum segment was opened along the axis and arranged into W shape. At the same time, two tips of ileum segment of 5 cm long were left unopened to be sewn up like rabbit-ears. Bilateral ureter was implanted into the two rabbit ears of the new bladder, respectively. In operation no double J-tube or other tube was indwelled inside the two ureters, and no tube was inserted into the ileal new bladder. When the tip of the new bladder forms anastomosis with the urethral, only foster ureter tube was left. Data such as operation time, complication and hospital stay were collected and evaluated. Results The mean operative time was 380, 402 and 430 min respectively. Besides one case of intestinal adhesion, no incision infection, urine leak, or other complication occurred. Conclusions Laparoscopic radical cystoprostatectomy with tubeless rabbit-type orthotopic ileal neobladder is feasible in selected bladder cancer.