五孔腹腔镜膀胱癌根治性切除术后联合小切口原位回肠新膀胱术23例分析

A Brief Introduction to the Standardized Procedures of Five-hole Laparoscopic Radical Cystectomy and Small-incision in Situ Ileal Neobladder Surgery

目的评价标准化流程五孔腹腔镜根治性膀胱切除术联合小切口原位回肠新膀胱术的有效性和安全性以及临床具体化操作流程优势。方法2017年9月至2022年9月,锦州医科大学附属第一医院的23例(其中男性20例、女性3例)膀胱癌患者按标准化流程接受腹腔镜膀胱根治性切除联合小切口原位回肠新膀胱术,收集并分析患者的人口学特征、围手术期结果、术后远(近)期并发症、病理结果及术后随访、生存状况。结果患者平均年龄61.7岁(47~73岁),所有患者手术均顺利完成,无中转开放手术及添加套管患者。平均手术时间464 min(260~750 min),平均出血量254 mL(90~450 mL)。术后30 d内并发症:Clavien I~Ⅱ级22例,ClavienⅢ~V级1例。平均清扫淋巴结19.3枚,17.4%患者淋巴结阳性。术后病理显示9例T_(1)N_(0)G_(3),2例T_(1)N_(1),5例T_(2)N_(0),5例T_(3)N_(0),1例T_(3)N_(1),1例T 4 N 1,手术切缘均为阴性。患者对术后外观满意。中位随访时间为24个月(2~48个月),其中4例患者术后因肠漏转入普外科,无局部复发患者,2例患者于术后12、15个月发现远处转移行化疗,患者均健在。术后6个月,患者白天均能达到良好控尿,其中4例患者夜间不能自主控尿。结论基于标准化流程腹腔镜膀胱根治性切除联合小切口原位回肠新膀胱技术可行,可明显缩减手术时间,降低手术难度及学习曲线,近期肿瘤根治效果良好,远期疗效及肿瘤控制效果仍有待更长期的大样本研究。

Objective To evaluate the effectiveness and safety of standardized five-hole laparoscopic radical cystectomy and small-incision in situ ileal neobladder surgery and the advantages of specific clinical procedures.Methods From September 2017 to September 2022,23 patients(20 males and 3 females)with bladder cancer in the First Affiliated Hospital of Jinzhou Medical University underwent laparoscopic radical cystectomy and small-incision in situ ileal neobladder surgery according to standardized procedures.Demographic characteristics,perioperative results,postoperative complications occurred in the near and distant periods,pathological results,postoperative follow-up,and survival status were collected and analyzed.Results The average age of the patients was 61.7 years old(47 to 73 years old),and All patients underwent successful surgery without transferring to open surgery or adding cannula patients.The average duration of surgery was 464 min(260 to 750 min),and the average bleeding volume was 254 mL(90 to 450 mL).Complications within 30 days after surgery:22 cases of Clavien grade I~II.and 1 case of Clavien grade III~V.On average,19.3 lymph nodes were dissected,and 17.4%of patients were positive for lymph nodes.Postoperative pathological manifestations were 9 cases of T_(1)N_(0)G_(3),2 cases of T_(1)N_(1),5 cases of T_(2)N_(0),5 cases of T_(3)N_(0),1 case of T_(3)N_(1),and 1 case of T_(4)N_(1),and the surgical margins were all negative.The patient is satisfied with the postoperative appearance.The median follow-up time was 24 months(2 to 48 months),of which 1 patient was transferred to general surgery due to intestinal fistula after surgery,and there was no local recurrence,and 2 patients were found to undergo distant metastases for chemotherapy at 12 or 15 months after surgery,and the patients were all alive.At 6 months after the operation,the patients were able to achieve good urinary control during the day,and 4 patients could not control their urine spontaneously at night.Conclusion Based on standardized procedures,laparoscopic radical cystectomy plus small incision in situ ileal new bladder technology,which can significantly reduce the operation time,the difficulty of surgery and the learning curve.The short-term tumor radical treatment effect is good,and the long-term efficacy and tumor control effect still need to be studied in a larger sample in a longer term.