腹腔镜下保留性神经和生殖道全膀胱切除术3例报告

Nerve-and-seminal sparing laparoscopic radical cystectomy:experience with 3 cases

目的探讨腹腔镜下保留性功能膀胱切除原位代膀胱术的可行性。方法我院2011年8月至2014年7月对3例年龄分别为37岁、45岁、38岁的男性患者施行了腹腔镜保留性神经和生殖道全膀胱切除原位代膀胱术,术中均行盆腔淋巴结清扫,同时保留患者输精管、精囊和神经血管束。结果前2例患者为浸润性高级别尿路上皮细胞癌,第3例为膀胱腺癌。3例患者术后均获得满意尿控,第1例和第3例患者性功能完全恢复,第2例患者离异不能进行正常性生活但有晨勃。第1、2、3例患者术后国际勃起功能指数(IIFF5)评分分别为22、12、23分,术后均无肿瘤复发或转移。结论对于经过严格选定的渴望保留控尿、性功能和生育功能的年轻膀胱癌患者,腹腔镜下保留性神经及生殖道全膀胱切除原位代膀胱术是一种安全有效的手术方式。

Objective To evaluate the efficacy and safety of laparoscopic nerve-and-seminal sparing cystectomy for the treatment of orthotopic neobladder.Methods Clinical data of 3 young patients treated in our hospital during Aug.2011 and Jul.2014 were retrospectively analyzed.The patients aged 37,45 and 38 years respectively.All patients received laparoscopic nerve-and-seminal sparing cystectomy with orthotopic intestinal neobladder and pelvic lymphnode dissection.The vas deferens,seminal vesicle and nerve vessel bundles（NVB）were preserved.Results Two cases were high-level invasive urothelial carcinoma as confirmed by pathological examination.The third case was adenocarcinoma of bladder.All regained satisfactory urinary control.Two patients regained satisfactory sexual function,the other had morning erection,but did not have a normal sexual function because of divorce.The postoperative IEFF5 scores of the 3 patients were 22,12,23,respectively.They had no tumor recurrence or metastasis.Conclusions Laparoscopic nerve-and-reproductive tract sparing cystectomy with orthotopic intestinal neobladder is a feasible reproducible surgical technique for patients who desire to preserve sexual function,fertility and continence.It represents a valid alternative to classic radical cystectomy.