经腹膜外途径腹腔镜膀胱全切术的初步经验(附6例报告)

The initial experience of extraperitoneal laparoscopic cystectomy(6 cases report)

目的:探讨经腹膜外途径行腹腔镜膀胱全切术的手术方法和临床效果。方法:选取2013年1月2014年8月收治的6例T2期的肌层浸润性膀胱癌男性患者。年龄5480岁,平均71.6岁。建立腹膜外腔隙后参照开放手术顺行膀胱切除法行腹腔镜根治性膀胱切除。尿流改道其中3例行双侧输尿管皮肤造口术,1例行原位新膀胱,2例行Brick回肠膀胱术。结果:6例患者均手术成功,无中转开放。根治性膀胱切除手术时间120200 min,平均1 36.7 min。术中出血量100350 ml,平均210 ml。术后平均住院时间716 d。术后随访318个月,肾功能均正常,未见局部复发或转移。结论:根据初期的手术操作经验和随访结果,经腹膜外途径腹腔镜膀胱全切术在临床上具有良好的可行性和安全性。

Objective:To evaluate the surgical procedures and clinical efficacy of extraperitoneal laparoscopic cystectomy.Methods:From Jan.2011 to Aug.2014,a total of 6 male patients with T_2 muscle-invasive bladder cancer underwent operations in our hospital.The age ranged from 54 to 80 years old with a mean of 71.6.After the extraperitoneal space was built,laparoscopic cystectomy was performed by referring to the open approach.Three cases were subjected to cutaneous ureterostomy,1 to orthotopic neobladder and 2 to ileal conduit respectively.Results:All the 6 patients were successfully operated.The operative time ranged from 120 to 200 min with a mean of 136.7 min.Estimated blood loss was 100 to 350 mL with a mean of 210 mL.The post-operative hospital stay was 7 to 16 days.All 6 patients were followed up from 3 to 18 months.The renal function of all patients was normal.No local recurrence or metastasis occurred.Conclusions:Extraperitoneal laparoscopic cystectomy is a safe and effective therapeutic method according to the initial experience and follow-up results.