腹腔镜辅助下无气腹小切口膀胱癌根治术的临床疗效

Open gasless minimum incision endoscopic radical cystectomy (MIE-RC) to treat bladder cancer

目的探讨腹腔镜辅助下无气腹小切口膀胱癌根治术的疗效和安全性。方法采用腹腔镜辅助下无气腹小切口方法对14例膀胱癌患者行膀胱癌根治术,观察患者的手术时间、术中出血量、术后并发症及住院时间等。结果 14例患者手术均顺利进行,平均手术时间为363 min（270-518 min）,术中平均出血量为540 ml（260-1 400 ml）,术后平均4.3 d肠道功能恢复,10.2 d拔除引流管,33 d出院。无一例出现术中、术后大血管损伤、直肠损伤、尿失禁、尿漏、肠漏等并发症发生。术后随访6-28个月,无一例肿瘤复发或肿瘤特异性死亡。结论腹腔镜辅助下无气腹小切口膀胱癌根治术是一种安全、有效的微创方法,经济易行,适宜于基层医院开展。

Objective To investigate the safety and efficacy of open gasless minimum incision endoscopic radical cystectomy （MIE- RC） to treat patients with muscle-invasive bladder cancer. Methods Clinical data, operative parameters and outcomes were analyzed in 14 patients undergoing MIE-RC. Results All operations were successful. Median operating time was 363 min （270-518 min） for all procedures,including MIE-RC,bilateral pelvic lymphadenectomy and urinary diversion. Median estimated blood loss was 540 ml （260-1 400min）. Restoration of bowel function, defined by the time until flatus and bowel movement,took an average of 4.3 days. Mean time until drainage tube removal was 10.2 days,and mean length of postoperative hospitalization was 33 days. No instances of major vascular injury,rectal injury,urinary incontinence, urinary leakage or intestinal leakage were observed. No cases of tumor recur- rence or disease-specific death were observed during follow-up lasting 6-28 months. Conclusions Open gasless MIE-RC appears to be safe and reliable and should be promoted.