Restorative proctocolectomy with ileal pouch-anal anastomosis(RP-IPAA) is the gold standard surgical treatment for ulcerative colitis.However,despite the widespread use of RP-IPAA,many aspects of this treatment still ...Restorative proctocolectomy with ileal pouch-anal anastomosis(RP-IPAA) is the gold standard surgical treatment for ulcerative colitis.However,despite the widespread use of RP-IPAA,many aspects of this treatment still remain controversial,such as the approach(open or laparoscopic),number of stages in the surgery,type of pouch,and construction type(hand-sewn or stapled ileal pouch-anal anastomosis).The present narrative review aims to discuss current evidence on the short-,mid-,and long-term results of each of these technical alternatives as well as their benefits and disadvantages.A review of the MEDLINE,EMBASE,and Ovid databases was performed to identify studies published through March 2016.Few large,randomized,controlled studies have been conducted,which limits the conclusions that can be drawn regarding controversial issues.The available data from retrospective studies suggest that laparoscopic surgery has no clear advantages compared with open surgery and that one-stage RP-IPAA may be indicated in selected cases.Regarding 2- and 3-stage RP-IPAA,patients who underwent these surgeries differed significantly with respect to clinical and laboratory variables,making any comparisons extremely difficult.The long-term results regarding the pouch type show that the W- and J-reservoirs do not differ significantly,although the J pouch is generally preferred by surgeons.Hand-sewn and stapled ileal pouch-anal anastomoses have their own advantages,and there is no clear benefit of one technique over the other.展开更多
目的:探讨单孔腹腔镜下根治性膀胱切除术联合原位回肠新膀胱术的疗效及安全性。方法:选取2017年01月至2019年12月于本中心收治的17例膀胱癌患者,其中7例患者在经尿道途径的辅助下行单孔腹腔镜根治性膀胱切除术联合原位回肠新膀胱术;另...目的:探讨单孔腹腔镜下根治性膀胱切除术联合原位回肠新膀胱术的疗效及安全性。方法:选取2017年01月至2019年12月于本中心收治的17例膀胱癌患者,其中7例患者在经尿道途径的辅助下行单孔腹腔镜根治性膀胱切除术联合原位回肠新膀胱术;另外10例为对照组,行多孔腹腔镜下根治性膀胱切除术联合原位回肠新膀胱术,并对两组患者围手术期资料、手术并发症以及术后随访情况进行分析。结果:两组共17例膀胱癌患者均顺利完成手术,无中转开放手术。两组患者的年龄、体质量指数(body mass index,BMI)等差异均无统计学意义(P>0.05)。单孔组与对照组平均手术时间分别为(341.4±52.1)min和(333.0±59.5)min,术中平均出血量分别为(206.4±104.6)mL和(190.5±82.3)mL,盆腔淋巴结清扫平均个数分别为17(7~22)个和18(12~23)个,术后平均住院天数分别为(25.1±5.4)d和(26.8±6.0)d,差异均无统计学意义(P>0.05)。而单孔组在术后VAS疼痛评分和切口满意度评分上则优于对照组(P<0.05)。其中单孔组患者术后随访12个月时患者的最大尿流量、最大膀胱容量、最大膀胱充盈量均明显比6个月时高,而随访12个月时患者的残余尿量较6个月时低,差异均具有统计学意义(P<0.05)。结论:经尿道辅助单孔腹腔镜下根治性膀胱切除术联合原位回肠新膀胱术是安全可行的,且术后的新膀胱功能较为良好。展开更多
目的探讨腹腔镜下保留神经膀胱全切联合抗反流新膀胱重建术的应用价值。方法回顾性分析2016年1月~2019年6月39例膀胱癌行腹腔镜下保留神经的根治性膀胱全切+输尿管与储尿囊抗反流回肠新膀胱构建的资料。男37例,女2例,平均年龄59(47~70)...目的探讨腹腔镜下保留神经膀胱全切联合抗反流新膀胱重建术的应用价值。方法回顾性分析2016年1月~2019年6月39例膀胱癌行腹腔镜下保留神经的根治性膀胱全切+输尿管与储尿囊抗反流回肠新膀胱构建的资料。男37例,女2例,平均年龄59(47~70)岁。采用前列腺筋膜内切除技术(女性保留卵巢、子宫等生殖器官)行膀胱全切,回肠壁瓣联合输尿管拖入吻合抗反流新膀胱构建。随访6个月以上。结果手术均顺利完成。平均手术时间306(260~470)min,其中抗反流新膀胱构建时间43(35~55)min。估计失血量253(150~800)ml。术后平均随访22.5(6~43)月,1例术后33个月肿瘤相关死亡。术后30天内并发症10例(26%),术后30天后并发症3例(8%),均为Clavien-Dindo 1~2级,无膀胱输尿管反流和吻合口狭窄。完全控尿率术后1、6、12个月日间分别为72%(28/39)、97%(38/39)和100%(38/38),夜间分别为54%(21/39)、72%(28/39)和84%(32/38)。37例男性患者术前国际勃起功能指数5(International Index of Erectile Function 5,IIEF-5)得分均≥15,术后6、12个月勃起功能恢复正常(IIEF-5得分≥15)占比分别为46%(17/37)和57%(21/37)。结论腹腔镜下保留神经的根治性膀胱切除+抗反流新膀胱术安全、有效,无严重并发症,短期肿瘤学结果和功能恢复较满意。展开更多
文摘Restorative proctocolectomy with ileal pouch-anal anastomosis(RP-IPAA) is the gold standard surgical treatment for ulcerative colitis.However,despite the widespread use of RP-IPAA,many aspects of this treatment still remain controversial,such as the approach(open or laparoscopic),number of stages in the surgery,type of pouch,and construction type(hand-sewn or stapled ileal pouch-anal anastomosis).The present narrative review aims to discuss current evidence on the short-,mid-,and long-term results of each of these technical alternatives as well as their benefits and disadvantages.A review of the MEDLINE,EMBASE,and Ovid databases was performed to identify studies published through March 2016.Few large,randomized,controlled studies have been conducted,which limits the conclusions that can be drawn regarding controversial issues.The available data from retrospective studies suggest that laparoscopic surgery has no clear advantages compared with open surgery and that one-stage RP-IPAA may be indicated in selected cases.Regarding 2- and 3-stage RP-IPAA,patients who underwent these surgeries differed significantly with respect to clinical and laboratory variables,making any comparisons extremely difficult.The long-term results regarding the pouch type show that the W- and J-reservoirs do not differ significantly,although the J pouch is generally preferred by surgeons.Hand-sewn and stapled ileal pouch-anal anastomoses have their own advantages,and there is no clear benefit of one technique over the other.
文摘目的:探讨单孔腹腔镜下根治性膀胱切除术联合原位回肠新膀胱术的疗效及安全性。方法:选取2017年01月至2019年12月于本中心收治的17例膀胱癌患者,其中7例患者在经尿道途径的辅助下行单孔腹腔镜根治性膀胱切除术联合原位回肠新膀胱术;另外10例为对照组,行多孔腹腔镜下根治性膀胱切除术联合原位回肠新膀胱术,并对两组患者围手术期资料、手术并发症以及术后随访情况进行分析。结果:两组共17例膀胱癌患者均顺利完成手术,无中转开放手术。两组患者的年龄、体质量指数(body mass index,BMI)等差异均无统计学意义(P>0.05)。单孔组与对照组平均手术时间分别为(341.4±52.1)min和(333.0±59.5)min,术中平均出血量分别为(206.4±104.6)mL和(190.5±82.3)mL,盆腔淋巴结清扫平均个数分别为17(7~22)个和18(12~23)个,术后平均住院天数分别为(25.1±5.4)d和(26.8±6.0)d,差异均无统计学意义(P>0.05)。而单孔组在术后VAS疼痛评分和切口满意度评分上则优于对照组(P<0.05)。其中单孔组患者术后随访12个月时患者的最大尿流量、最大膀胱容量、最大膀胱充盈量均明显比6个月时高,而随访12个月时患者的残余尿量较6个月时低,差异均具有统计学意义(P<0.05)。结论:经尿道辅助单孔腹腔镜下根治性膀胱切除术联合原位回肠新膀胱术是安全可行的,且术后的新膀胱功能较为良好。
文摘目的探讨腹腔镜下保留神经膀胱全切联合抗反流新膀胱重建术的应用价值。方法回顾性分析2016年1月~2019年6月39例膀胱癌行腹腔镜下保留神经的根治性膀胱全切+输尿管与储尿囊抗反流回肠新膀胱构建的资料。男37例,女2例,平均年龄59(47~70)岁。采用前列腺筋膜内切除技术(女性保留卵巢、子宫等生殖器官)行膀胱全切,回肠壁瓣联合输尿管拖入吻合抗反流新膀胱构建。随访6个月以上。结果手术均顺利完成。平均手术时间306(260~470)min,其中抗反流新膀胱构建时间43(35~55)min。估计失血量253(150~800)ml。术后平均随访22.5(6~43)月,1例术后33个月肿瘤相关死亡。术后30天内并发症10例(26%),术后30天后并发症3例(8%),均为Clavien-Dindo 1~2级,无膀胱输尿管反流和吻合口狭窄。完全控尿率术后1、6、12个月日间分别为72%(28/39)、97%(38/39)和100%(38/38),夜间分别为54%(21/39)、72%(28/39)和84%(32/38)。37例男性患者术前国际勃起功能指数5(International Index of Erectile Function 5,IIEF-5)得分均≥15,术后6、12个月勃起功能恢复正常(IIEF-5得分≥15)占比分别为46%(17/37)和57%(21/37)。结论腹腔镜下保留神经的根治性膀胱切除+抗反流新膀胱术安全、有效,无严重并发症,短期肿瘤学结果和功能恢复较满意。
