膀胱癌全腹膜外回肠膀胱术术式改良探讨

Modification of procedure of total extraperitoneal ileal conduit

目的探讨侧腹膜小切口回肠拖出法在全腹膜外回肠膀胱术中的应用。方法选择2011-01至2014-12我科室膀胱癌患者57例。入选标准为病理确诊尿路上皮癌,临床分期为T2b^T4a,预期寿命>1年患者。其中常规手术组27例,侧腹膜切口采用传统大切口手术方法;改良手术组30例,侧腹膜切口采用侧腹膜小切口回肠拖出法。对比两组关闭侧腹膜针数、术中耗时、术中出血量、游离腹膜面积、侧腹膜切口长度、术后患者排气时间、术后出现内疝及早期肠梗阻原因,术后回肠膀胱血运及坏死情况。结果两组术后排气时间分别(72±6)、(72±10)h,两组间比较差异无统计学意义。改良组与常规组术中侧腹膜分别缝针(5±2)针、(12±2)针,耗时分别为(15±5)min、(25±5)min,出血量分别为(10±5)ml、(30±8)ml,腹膜游离面积分别为(20±5)cm2、(45±5)cm2,侧腹膜切口长度分别为(3±1)cm、(12±2)cm,组间比较差异均有统计学意义(P<0.05)。结论通过改良可明显缩短手术时间,减少手术造成腹膜损失,减少出血量,明显降低手术难度,且不增加手术并发症。

Objective To study the application of pulling out ileum from small lateral peritoneum incision in total extraperitoneal ileal conduit. Methods 57 bladder cancer patients admitted from January 2011 to December 2014 in this department were recruited. The inclusion criteria included pathologically confirmed urothelial carcinoma,clinical stage T2b-T4 a,and expected survival 1 year. 27 patients received conventional procedure,with traditional large incision applied during lateral peritoneum incision; 30 patients received modified procedure,with ileum dragging out through small lateral peritoneum incision. The differences between the two groups regarding numbers of stitches during lateral peritoneum incision suture,time consumed for the surgery,intraoperative blood loss,area of peritoneum isolated,lateral peritoneum incision length,the time to first post-operative anal exhaust,the reasons for postoperative internal hernia and early intestinal obstruction,as well as post-operative blood supply for ileal conduit and whether necrosis showed up. Results The time to first post-operative anal exhaustion for the two group were（ 72 ± 6） h and（ 72 ± 10） h,respectively,and the difference was not statistically significant. For modified group and conventional group,the numbers of stitches applied during lateral peritoneum incision suture were（ 5 ± 2） and（ 12 ± 2）,time consumed were（ 15 ± 5） min and（ 25 ± 5） min,blood loss were（ 10 ± 5） ml and（ 30 ± 8） ml,the area of peritoneum isolated were（ 20 ± 5） cm2,and（ 45 ± 5） cm2,and lateral peritoneum incision length were（ 3 ± 1） cm and（ 12 ± 2） cm,respectively. The differences between the two groups were statistically significant（ P 〈0. 05）. Conclusions Modified procedure can shorten the time consumed during procedure,reduce peritoneum loss and blood loss,as well as simplify procedure without more procedure-induced complications.