保留膀胱治疗后完全机器人辅助腹腔镜根治性膀胱切除术+原位回肠膀胱1例报告

Totally intracorporeal robot-assisted orthotopic ileal neobladder after bladder preservation therapy:a case report

患者,男,56岁。因膀胱癌反复复发于2021年11月29日入院。患者因膀胱癌既往有开放膀胱部分切除术史、同步放化疗治疗史、4次经尿道膀胱肿瘤切除术史。本次入院CT检查示膀胱左侧壁膀胱癌,肿瘤分期T3期;继发左肾积水。全麻下行机器人辅助腹腔镜根治性膀胱切除术+完全腹腔内原位回肠新膀胱。手术顺利,患者恢复良好,术后7 d出院。术后病理诊断为膀胱高级别尿路上皮癌,病理分期T2b期,伴左侧盆腔淋巴结转移。术后3个月复查,患者无复发表现,新膀胱功能良好,日间可完全控尿,肠道和肾功能恢复好。目前正在接受吉西他滨联合顺铂辅助化疗。对于有手术史和放疗史的膀胱癌患者,根治性膀胱切除术+原位回肠膀胱的手术难度高,术者丰富的腹腔镜手术经验和机器人辅助手术的精细化特点是完成此类手术的重要前提。

The patient,a 56-year old male,was admitted to the hospital for recurrent bladder cancer in November 29,2021.The patient had previously undergone partial cystectomy,simultaneous radio-chemotherapy to preserve the bladder,and repeated 4 times TURBt.CT suggested T3 stage bladder cancer in left bladder wall,and causing left hydronephrosis.Under general anesthesia,robot-assisted laparoscopic radical cystectomy and complete intraperitoneal orthotopic ileal neobladder reconstruction were performed.The operation was successful,the postoperative recovery was good,and the patient was discharged 7 days after surgery.Postoperative pathological diagnosis was T2b,high-grade urothelial carcinoma with left pelvic lymph node metastasis.Three months after operation,the patient had no recurrence,the new bladder function was good,the urine could be completely controlled during the day,and the intestinal and renal functions recovered well.At present,we carried out adjuvant chemotherapy(Gemcitabine+Cisplatin)to this patient.The technical of radical cystectomy and orthotopic ileal neobladder with a history of surgery and radiotherapy is high,expensive experience in laparoscopic surgery and elaborate actions of robotic surgery are important prerequisites for completing such surgery.