腹腔镜下全膀胱切除术(4例初步报道)

Laparoscopic Total Cystectomy (A Report of 4 Cases)

目的 介绍腹腔镜下全膀胱切除治疗浸润性膀胱癌的经验。 方法 对 4例浸润性膀胱癌患者行腹腔镜下全膀胱切除 ,开腹行下尿路重建 (乙状结肠原位新膀胱 3例 ,直肠膀胱 1例 )。对术后肿瘤控制和尿液控制情况进行随访。 结果 全膀胱切除时间 6～ 8h ,术中出血 6 0 0～ 16 0 0ml。全部病人自主排尿 ;完全控尿 3例 ,压力性尿失禁 1例。 2例T2aN0M 0患者随访 16和 2 0个月无瘤生存 ,1例T2aN1M 0和 1例T4aN0M0患者已分别随访 6和 2 9个月 ,已出现淋巴结和骨转移 ,带瘤生存。 结论 腹腔镜下全膀胱切除治疗膀胱癌方法可行 ,但对肿瘤控制的远期效果有待进一步研究。

Objective To report our initial experience in laparoscopic total cystectomy for the treatment of invasive bladder cancer. Method Four patients with invasive bladder cancer underwent total cystectomy laparoscopically and urinary diversion extracorporeally (sigmoid neobladder in sute in three cases and rectal sigmoid pouch in one). The patients were followed up for tumor control as well as urinary control. Results The time for laparoscopic total cystectomy was 6～8 hours. The blood loss was 600 ml～1 600 ml. All patients voided smoothly. Three patients were continent completely. One patient had stress urinary incontinence. Two cases with T2aN0M0 were followed up for 16 and 20 months respectively and no tumor relapsed. The patient with T2aN1M0 was followed up for 6 months and survived with lymph node metastases. The other patient with T4aN0M0 was followed up for 29 months and survived with bone metastases. Conclusion Laparoscopic total cystectomy is feasible for the treatment of bladder cancer, but its long-term effect on tumor control needs further study.