程序化流程腹腔镜膀胱根治性切除+Studer新膀胱术的初步探讨

Preliminary study on laparoscopic radical cystectomy with Studer orthotopic neobladder

目的:评价程序化流程进行腹腔镜膀胱根治性切除+Studer原位新膀胱术的安全性和有效性,并加深对其流程的认识。方法:回顾性分析2017年12月～2018年6月我院收治的10例按程序化流程行腹腔镜膀胱根治性切除+Studer新膀胱术的膀胱癌患者的临床资料,包括患者年龄、性别、手术时间、术后并发症、术后病理及术后短期尿控能力等。结果:患者年龄43～71岁,平均60岁,所有患者均按照流程顺利完成手术,平均手术时间约296min,平均失血量约145ml。术后病理提示2例T_aN_0M_0,5例T_1N_0M_0,3例T_2N_0M_0,清扫淋巴结均为阴性,手术切缘均为阴性。短期随访过程中其中一例尿道狭窄入院,再次行尿道内切开术;1例由于孤立肾输尿管狭窄行肾穿刺造瘘术;现患者均健在,未发生局部转移,白天和夜晚有良好的尿控能力。结论:程序化流程腹腔镜膀胱根治性切除+Studer原位新膀胱术操作简单,短期肿瘤根治效果良好并且具有良好的尿控能力,远期疗效及肿瘤控制效果仍有待对更大样本进行长期随访。

Objective:To evaluate the safety and effectiveness of laparoscopic radical cystectomy with Studer orthotopic neobladder,and to deepen the understanding of the process.Method:We retrospectively analysed 10 cases of bladder cancer undergoing laparoscopic radical cystectomy with Studer orthotopic neobladder according to the process from Dec.2017 to Jun.2018,and collected the patients’data including age,sex,operation time,introperative blood loss,complications,pathological results and postoperative short-term urinary control ability.Result:The average age of the patients was 60(range,43-71)years old.All patients were successfully completed the operation according to the process.The average operation time was about 296min,the average blood loss was about145ml.Postoperative pathology indicated:2 case TaN0M0,5 cases T1N0M0,3 cases T2N0M0,the operative margin was negative.In the course of short-term follow-up,in one case urethral incision was performed,in another case,renal perforation fistula was performed due to ureteral stenosis;Patients are all alive,no local metastasis occurred,and they have good urinary control ability during the day and night.Conclusion:The process of laparoscopic radical cystectomy with Studer orthotopic neobladder has obvious advantages,short-term radical tumor treatment is good and has good urinary control ability.However,long-term efficacy and tumor control effect still need long-term follow-up larger samples.