膀胱镜和腹腔镜双镜联合手术治疗膀胱憩室分析

Preliminary Experience of Combined Operation of Cystoscopy and Laparoscopy in the Treatment of Bladder Diverticulum

目的:探讨膀胱镜和腹腔镜双镜联合手术治疗膀胱憩室的方法。方法:收集2013年4月~2020年3月于本院行腹腔镜和膀胱镜双镜联合膀胱憩室切除手术病例6例。其中男5例,女1例,年龄36~72岁。5例为前列腺增生导致膀胱憩室,1例为原发性膀胱憩室,憩室最大直径48~112mm,憩室盏口直径6~20mm。6例病例均行腹腔镜和膀胱镜双镜联合膀胱憩室切除术。术中膀胱镜光源实时导航,协助寻找到憩室及憩室颈口位置,膀胱镜和腹腔镜双镜观察下,用超声刀切除憩室,缝合膀胱壁黏膜层、肌层及桨膜层。结果:6例手术均顺利完成,共切除6个膀胱憩室,无出现中转开放手术。手术时间155~265min,术中出血量30~80mL。术中无输尿管损伤、输尿管口损伤及周围器官损伤。术后盆腔引流管拔除时间4~13d,术后住院时间4~18d。6例患者术后均无出现尿外渗,无输血。1例术前存在泌尿系感染病例,术后出现发热、尿细菌培养阳性,经抗感染后体温恢复正常、尿培养阴性。术后14d拔除尿管,均恢复正常排尿。随访时间3~83个月,6例均无复发,排尿症状明显改善。结论:腹腔镜和膀胱镜双镜联合膀胱憩室切除术,术中可借膀胱镜进行实时导航,明确憩室及其开口位置,降低手术难度,减少手术副损伤。实现精准切除、精准缝合,降低术后尿外渗等并发症。

Objective:To explore the preliminary experience of cystoscopy and laparoscopy combined surgery for the treatment of bladder diverticulum.Methods:A total of 6 cases,including 5 males and 1 female,aged 36 to 72 years,who underwent laparoscopic and cystoscopy combined bladder diverticulectomy in our hospital from April 2013 to March 2020 were collected.Five cases were bladder diverticulum caused by benign prostatic hyperplasia,and one case was primary bladder diverticulum.The maximum diameter of the diverticulum was 48-112 mm,and the diameter of the diverticulum calyx was 6-20 mm.All 6 cases underwent laparoscopic and cystoscopy combined diverticulectomy.Intraoperative cystoscope light acted in real time to assist in finding the location of the diverticulum and neck of the diverticulum.Under the observation of the cystoscope and laparoscope,the diverticulum was excised with an ultrasonic knife,and the mucosal layer,muscular layer and paddle layer of the bladder wall were sutured.Results:All 6 operations were successfully completed.The operation time was 155 to 265 minutes,and the intraoperative blood loss was 30 to 80 mL.There was no ureteral injury,ureteral orifice injury and peripheral organ injury during the operation.The pelvic drainage tube removal time was 4 to 13 days after operation,and the hospital stay was 4 to 18 days after operation.No urinary extravasation and no blood transfusion occurred in 6 patients.One patient had a fever after operation.The urinary catheter was removed 14 days after surgery,and all returned to normal urination.During the follow-up period of 3 to 83 months,6 patients had no recurrence,and urination symptoms were significantly improved.Conclusion:In laparoscopic and cystoscopy combined bladder diverticulectomy,cystoscope can be used for real-time navigation during the operation,clarifying the location of the diverticulum and its opening,and reducing the injury of surgical side injury.It is a minimally invasive surgical technique suitable for popularization to achieve precise resection,precise suture,and reduce postoperative urine extravasation and other complications.