腹腔镜下膀胱根治性切除-原位回肠新膀胱术:附22例报告

Laparoscopic radical cystectomy with orthotopic ileal neobladder : report of 22 cases

目的探讨腹腔镜下膀胱根治性切除-原位回肠新膀胱术治疗肌层浸润性膀胱癌的手术疗效及并发症。方法回顾性分析惠州市中心人民医院自2005年10月至2013年10月开展腹腔镜下膀胱根治性切除-原位回肠新膀胱术患者的临床资料,22例确诊为浸润性膀胱癌患者,其中男18例,女4例,对手术时间、出血量及随访结果等进行分析。结果平均手术时间为6.5 h,平均出血量为362 ml,无中转开放手术,无围手术期死亡病例,所有患者手术切缘均为阴性。术后随访12-106个月,随访期间死亡7例,其中与肿瘤相关死亡5例。结论腹腔镜下膀胱根治性切除-原位回肠新膀胱术在具有腹腔镜技术的综合医院开展是可行的,其并发症较少及具有较好的新膀胱功能。

Objective To explore the efficaly, complication, and outcome of laparoscopic radical cystectomy with orthotopic ileal neobladder for treatment of muscle- invasive bladder cancer. Method Clinical data of 22 patients （18 males and 4 females） with bladder cancer and underwent laparoscopic radical cystectomy with orthotopic ileal neobladder were retrospectively analyzed. Results The mean operation time was 6.5 hours, the mean blood loss was 362 ml. Conversion to open surgery was not performed in any cases. The peri-operative mortality was zero and surgical margins were tumor negative in all cases. The patents were followed-up for 12-106 months. 5 cases were died of tumor-related disease and 2 cases died of diseases inrelated to tumor. Conclusion Laparoscopic radical cystectomy with extracorporeal formation of orthotopic ileal neobladder is feasible technique with low morbidity and acceptable neobladder function, should be carried out in primary-level hospital with laparoscopy.