腹腔镜肿瘤剜除术治疗浆膜下型膀胱平滑肌瘤的临床体会

Clinical experiences of laparoscopic enucleation of subserosal bladder leiomyoma

目的探讨腹腔镜肿瘤剜除术治疗浆膜下型膀胱平滑肌瘤的疗效及安全性。方法回顾性分析2010年9月到2016年11月腹腔镜治疗膀胱浆膜下平滑肌瘤8例患者资料,其中男性5例,女性3例,年龄31~65(平均47±10)岁,主诉为膀胱刺激症状者3例,下腹痛者2例,无临床症状、体检发现者3例。病程1周至3年,平均21个月。所有患者术前均行尿常规、超声、CT尿路成像(CTU)、膀胱镜等检查,尿常规均正常。结果 8例患者均行腹腔镜膀胱肿瘤剜除治疗且完整剜出肿块,快速病理均示平滑肌瘤,术后病理示膀胱平滑肌瘤,其中7例患者因膀胱黏膜完好未予缝合。手术时间40~70(53±10)min,术中出血20~50(34±10)ml,术后随访3~12个月(平均7.5个月)均未见肿瘤复发且未诉尿瘘等常见并发症。结论对于浆膜下型膀胱平滑肌瘤,腹腔镜下膀胱肿瘤剜除术是安全、有效的手术方法。

Objective To explore the efficacy and safety of laparoscopic enucleation of subserosal bladder leiomyoma. Methods The clinical data of 8 patients with subserosal bladder leiomyoma（5 male and 3 female） from September 2010 to November 2016 were retrospectively analyzed. The age was 31-65（mean 47±10） years. Clinical manifestation included irritative bladder 3 cases, hypogastralgia 2 cases and no clinical symptoms 3 cases. Ultrasonography and CT Urography（CTU） were performed in all 8 cases. The course of disease ranged from 1 week to 3 years（mean 21 months）, Routine urines of all patients were normal. Results Eight cases were treated with laparoscopic enucleation of bladder tumor that were enucleated completely. Rapid pathology showed leiomyoma. Postoperative pathology showed bladder leiomyoma. Seven patients were not sutured due to intact bladder mucosa, and there was no obvious postoperative complication. The operation time was 40-70 mins, with an average of（53±10） mins. The blood loss was 20-50 ml, with an average of（34±10） ml. No recurrence was found in 8 cases after operation follow-up of 3 to 12 months（mean 7.5 months） and no common complication was found in 8 cases such as urinary fistula. Conclusion Laparoscopic enucleation is a safe and effective surgical technique for treating subserosal bladder leiomyoma with excellent results.