乙状结肠原位新膀胱技术改良与实践(“大家泌尿网”观看手术视频)

Technical improvement and practice of orthotopicsigmoid neobladder

根治性膀胱切除术及尿流改道是目前治疗肌层浸润性膀胱癌的标准术式,其中原位新膀胱是应用最为广泛的可控性尿流改道方法。我中心在30余年临床实践中进行技术改良,演进出新的手术方式:去管化乙状结肠U型原位新膀胱术。截取25cm乙状结肠,U型摆放后将其对系膜缘去管化,构建储尿囊。对于输尿管-新膀胱吻合,采取自创的肠系膜浆膜下隧道吻合技术。该法操作简单,易于学习,二者结合可重塑膀胱颈及膀胱三角,并发症少,有一定推广价值。

Radical cystectomy and urinary diversion are currently standardized procedures in the treatment of muscle-invasive bladder cancer,of which orthotopic neobladder is the most widely used urinary diversion method.In more than 30 years of clinical practice,our center has made technical improvements and evolved a new surgical approach:detubelized U-shaped orthotopic sigmoid neobladder.A 25 cm sigmoid colon is sectioned,arranged in a U-shape,and detubulated against the mesenteric margin to form neobladder.For uretero-neobladder anastomosis,a self-initiated submesenteric plasma tunnel anastomosis technique is used.This method is easy to perform and learn.The combination of the two operations can reshape the bladder neck and bladder triangle,has few complications,and is worth of promoting.