腹腔镜下全膀胱切除术加原位回肠代膀胱术治疗浸润性膀胱癌疗效分析

Laparoscopic Combined with Small Incision Radical Cystectomy Plus Orthotopic Ileal Neobladder for the Treatment of Invasive Bladder Cancer(Report of 10 Cases)

目的:探讨腹腔镜联合小切口全膀胱切除术+原位回肠代膀胱术可行性及治疗浸润性膀胱癌的效果。方法:先在腹腔镜下对10例浸润性膀胱癌患者行全膀胱切除术,并在下腹部行小切口体外建成W形回肠代膀胱储尿囊,再在腹腔镜下行原位回肠代膀胱与尿道吻合术,观察疗效。结果:所有手术均获成功,无中转开腹。10例手术,历时420-480min,平均456min,术中出血600-1 200ml,平均850ml。术中未发生直肠损伤,术后10例均有不同程度漏尿,9例1周后拔除盆腔引流管,1例3周漏尿停止拔除引流管,无1例盆腔内感染及肠瘘,病理诊断均为浸润性尿路上皮癌,其中1例盆腔淋巴结阳性。所有病例无漏尿及吻合口狭窄等并发症,术后3个月复查B超无肾积水表现,无慢性尿潴留表现。复查血生化指标无电解质紊乱。1例患者术后2个月出现持续腹胀,考虑为粘连性肠梗阻。其余病例术后随访1-3年,无肿瘤复发。结论:腹腔镜联合小切口全膀胱切除术+原位回肠代膀胱术具有创伤小、出血少、术后恢复快的优点,提高了患者生活质量,是治疗浸润性膀胱癌的一种理想方式,在基层医院开展亦有可行性。

Objective. To explore the feasibility and the curative effect of laparoscope combined with small incision radical cystectomy plus orthotopic ileal neobladder. Methods： Ten patients of inva- sire bladder cancer underwent laparoscopic radical cystectomy at first, and a W shaped ileal pouch was built with small incision of the lower abdomen in vitro, then orthotopic ileal bladder and ure- ter under laparoscope was anastomosised. We observed the curative effect of patients. Results： All the operations were successful and no patient was changed for open surgery in 10 cases, with the operating time ranging fom 420 to 480 minutes （456 minutes on average） and blood lose from 600 to 1 200 ml （850 ml on average）, and no rectal injury was found. After operation, 10 casesboth had different degrees of bladder and urethra anastomotic fistula, in which 9 cases were re- moved pelvic drainage after 1 week, and I case was removed after 3 weeks, no case had pelvic in- fections and intestinal fistula, the pathological diagnosis was invasive urothelial carcinoma, inclu- ding 1 case of positive pelvic lymph node. No leakage of urine, anastomotic stenosis and other complications were found, no chronic urinary retention performance and hydrocephalus were de- tected according to the exam of ultrasound after 3 months. One patient who had persistent ab- dominal distension for two months after operation was diagnozed as intestinal obstruction. The rest cases were followed up from 1 to 3 years, and no recurrence or distant metastasis was found. Conclusion： Laparoscope combined with small incision radical cystectomy plus orthotopic ileal neoblad- der has the advantages of minimal invasion, less bleeding, faster postoperative recovery, and could im- prove the quality of life of patients. It is an ideal way of treatment of invasive bladder cancer.