膀胱镜与腹腔镜联合在复杂的膀胱部分切除手术中的应用

Application of cystoscopy-assisted extraperitoneal partial cystectomy of complex bladder tumor

目的探讨膀胱镜辅助腹腔镜(双镜联合)经腹膜外途径在复杂膀胱部分切除中的应用价值。方法回顾分析江苏省苏北人民医院2012-2015年间57例行手术治疗的膀胱癌患者的临床资料。其中膀胱镜与腹腔镜联合下经腹膜外途径膀胱部分切除术(双镜联合组)患者17例,腹腔镜下经腹腔途径膀胱部分切除术(部分切除组)20例,腹腔镜下根治性膀胱切除术(根治组)20例。分别比较双镜联合组与其他2组患者在手术时间、术中出血量及术后并发症、复发率等指标上的差异。双镜联合组具体术式为膀胱镜观察、引导,经腹膜外途径腹腔镜下膀胱部分切除。结果57例患者均成功实施手术治疗,双镜联合组与部分切除组在手术时间、术中出血量及术后并发症等指标上并无明显差异(P>0.05),双镜联合组的手术时间、术中出血量明显少于根治组,而在术后复发率上差异无明显统计学意义。结论双镜联合下的膀胱部分切除术治疗复杂的膀胱癌具有安全、创伤小及术后生活质量高等优势,可作为治疗该类膀胱肿瘤的一种补充治疗方式。

Objective To explore the application value of cystoscopy-assisted laparoscopic extraperitoneal partial cystectomy of complex bladder tumor.Methods Clinical data of 57 patients with bladder cancer who underwent surgical treatment during 2012 and 2015 in Subei People’s Hospital of Jiangsu Province were retrospectively analyzed,inducing 7 cases treated with cystoscopy-assisted laparoscopic extraperitoneal partial cystectomy(combined group),20 cases with laparoscopy transperitoneal cystectomy(partial group),and 20 cases with laparoscopic radical cystectomy(radical group).The differences in operation time,intraoperative blood loss,postoperative complications and recurrence rate were compared.In the combined group,partial cystectomy was performed via extraperitoneal approach with the guidance of cystoscope.Results All operations were successful.There were no significant differences in terms of operation time,intraoperative blood loss and postoperative complications between the combined group and the partial group(P>0.05).The operation time and intraoperative blood loss were significantly less in the combined group than in the radical group,but no significant difference in postoperative recurrence rate was observed.Conclusion Cystoscopy-assisted extraperitoneal partial cystectomy is supplementary in the treatment of complex bladder tumor as it is safe,minimally invasive and can maintain patients’quality of life.