全膀胱切除回肠膀胱术的疗效探讨(附68例报告)

目的:探讨全膀胱切除回肠膀胱术的临床治疗效果.方法:回顾性分析1997年1月～2007年3月因膀胱肿瘤行全膀胱切除回肠膀胱术68例患者的临床资料.结果:68例中,膀胱肿瘤均累及膀胱颈部或膀胱三角区,其中移行细胞癌62例(91.18%),其他类型肿瘤6例;浸润性膀胱癌61例(89.71%);术后发生近期并发症47例(69.12%),远期并发症7例(10.29%).55例随访1～10年,平均5.6年,5年生存率39.71%.结论:全膀胱切除是浸润性膀胱癌首选治疗方法,回肠膀胱术简单易行,术后并发症少,疗效确切,早期手术生存率高,是一种值得推荐的尿流改道方式.     

全膀胱切除直肠代膀胱与回肠膀胱术疗效观察

目的:探讨膀胱全切直肠代膀胱与回肠膀胱术的效果。方法:回顾性分析全膀胱切除直肠代膀胱130例,回肠膀胱16例临床资料。结果:143例膀胱肿瘤病例,浸润性肿瘤132例。手术均顺利,术后3个月未发现上尿路梗阻积水,电解质、肾功正常范围。发生近期并发症12例,远期并发症11例。87例随访1～10年,5年生存率63%。结论:膀胱全切是浸润性膀胱癌首选治疗方法之一,直肠代膀胱和回肠膀胱都是尿流改道的较好选择,长期随访其并发症少。     

全膀胱尿道切除回肠膀胱术治疗膀胱癌26例疗效探讨

目的 探讨膀胱癌行全膀胱及尿道切除回肠膀胱术(Bricker术)的临床治疗效果.方法 回顾性分析26例膀胱癌患者,一期施行膀胱及尿道全切回肠代膀胱尿流改道术的临床资料.结果 所有病例术后均恢复良好,出现近期并发症5例,无远期并发症.26例均获随访1~10年,平均6.2年,5年生存率67.5%.结论 对于膀胱癌侵犯尿道及前列腺无法保留尿道的患者,采取一期切除膀胱及全尿道回肠膀胱尿流改道术,操作简单易行,术后恢复快、并发症少、疗效确切,推荐为此类患者的优先选择.     

全膀胱切除正压可控低压U型回肠代膀胱术101例临床分析

目的 全膀胱切除是浸润性膀胱癌和多发性膀胱癌的标准治疗方法，不同尿流改道方式对生活质量影响差别很大。为解决全膀胱切除后贮尿、控尿和排尿问题，本文总结正压可控性低压U型回肠代膀胱术的手术经验。方法 1994年6月～2005年1月共施行了101例全膀胱切除正压可控性低压U型回肠代膀胱术。回顾性分析这些患者的临床资料，总结该方法的手术指征和临床效果。结果 101例手术顺利，无手术死亡。手术时间为4～6．5h，平均5h，随访3～48个月，平均30个月，101例U型回肠膀胱均能自行排尿，其中96例（95．0％）白天完全控尿，69例（68．3％）昼夜完全控尿，32例（31．7％）夜间尿失禁。术后无并发症，随访期内无肿瘤复发，死亡3例，1例于术后9天死于手术后急性心肌梗死，2例于术后2年死于脑出血。结论 对浸润性膀胱癌和多发性膀胱癌应尽早行全膀胱切除，正压可控性低压U型回肠代膀胱术，操作简单、安全、可靠，术后生活质量提高，且远期效果良好，值得临床广泛应用。     

改良膀胱全切除原位回肠新膀胱术后效果探析

目的探讨改良膀胱全切除原位回肠新膀胱手术的临床效果。方法对18例浸润性膀胱癌患者行改良膀胱全切除原位回肠新膀胱手术治疗,记录手术时间、术中输血量、术后并发症、术后排尿情况、肿瘤控制情况和生存质量等。结果 18例患者均顺利完成手术,平均手术时间250 min。术中输血量平均470 mL。术后3例出现早期并发症,其中电解质紊乱2例,尿瘘1例。18例患者均获随访,平均时间20个月,1例发生单侧输尿管反流,1例死于脑梗死,1例死于肿瘤转移,1例死于肾功能衰竭。术后患者的生活质量比较满意。结论改良膀胱全切除原位回肠新膀胱手术术式简单、术后并发症少和代膀胱功能好,是浸润性膀胱癌较为理想的治疗术式。     

改良膀胱全切除原位回肠新膀胱术后疗效观察

目的报告改良膀胱全切除原位回肠新膀胱术治疗肌层浸润性膀胱癌的疗效。方法对我院2007年1月至2011月12月施行改良膀胱全切除原位回肠新膀胱术的24例患者的临床资料进行回顾性分析,包括手术时间、手术出血量、输血情况、手术并发症、新膀胱功能、肿瘤控制情况、生存情况、勃起功能以及生活质量情况。结果本组24例手术均顺利,手术时间240～380min,术中出血量200～1200ml,输血11例,术中直肠损伤1例。术后8例出现早期并发症,其中5例电解质紊乱,1例肠梗阻,2例尿瘘;另有2例真性尿失禁。20例获随访,1例死于肺部感染,1例死于脑梗死,1例死于梗阻性肾功能不全,1例死于肿瘤复发、转移,1例因肿瘤复发、转移而目前在接受放化疗中,15例无瘤生存。术后性功能均有不同程度下降。生活质量大致满意。结论对于肌层浸润性膀胱癌患者,实施改良膀胱全切除原位回肠新膀胱术效果良好,提高手术技巧是术后改善生活质量的重要因素之一。     

腹腔镜下全膀胱切除术(4例初步报道)

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l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600-l600ml。全部病人自主排尿；完全控尿3例，压力性尿失禁l例。2例T2aNOM0患随访16和20个月无瘤生存，1例T2aNlM0和1例T4aNOM0患已分别随访6和29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。     

女性原位回肠代膀胱术的临床应用

目的:总结女性膀胱全切患者行原位回肠代膀胱术的临床疗效。方法:回顾性分析1998年1月～2006年2月36例女性膀胱全切,原位回肠代膀胱患者的临床资料。36例患者,年龄48～65岁,平均56岁。其中移行细胞癌34例,腺癌2例。原发肿瘤22例,复发性肿瘤14例。多发性非肌层侵犯肿瘤(Ta～T1)12例,浸润性膀胱肿瘤(T2～T3)24例。结果:36例手术平均时间270min(210～330min),输血量平均400ml(0～1000ml)。术后随访6～72个月,平均26个月。术后6个月昼夜控尿率分别为94%(34/36)和92%(33/36)。2例排尿可控过度,需间歇导尿。术后6个月IVU检查无输尿管狭窄和反流。血电解质和肾功能正常,无尿道残端肿瘤复发。结论:原位回肠代膀胱术治疗女性膀胱癌患者临床疗效满意,可作为广泛开展的术式。     

腹腔镜根治性全膀胱切除回肠新膀胱术治疗浸润性膀胱癌（附30例报告）

目的 探讨腹腔镜下根治性全膀胱切除原位回肠新膀胱术的手术方法及临床疗效.方法 收集2007年5月至2011年10月应用腹腔镜下根治性全膀胱切除原位回肠新膀胱术的浸润性膀胱癌患者30例.对其临床资料进行回顾性分析和总结.结果 所有手术均获得成功,无中转开放,手术时间180～360 min（平均240 min）,术中出血量150～450mL（平均220 mL）.术后4～8d恢复肠道正常蠕动功能,随访时间6～60个月,中位随访时间26个月.30例术后均能恢复较满意的控尿功能,平均膀胱容量约398mL,平均夜尿1～3次;1例出现夜间遗尿;2例出现尿漏;膀胱镜检查无尿道肿瘤复发;2例死于原发病转移.其余患者术后随访6个月血生化指标均正常,B超检查未见上尿路扩张积水.结论 腹腔镜下根治性全膀胱切除原位回肠新膀胱术具有创伤小、出血少、盆腔淋巴结清扫彻底、术后恢复快、术后控尿满意等优点,是治疗浸润性膀胱癌的一种理想手术方式.     

腹腔镜根治性全膀胱切除回肠新膀胱术治疗浸润性膀胱癌（附30例病例报告）

目的 探讨腹腔镜下根治性全膀胱切除原位回肠新膀胱术的手术方法及临床疗效。方法 收集2007年5月至2011年10月应用腹腔镜下根治性全膀胱切除原位回肠新膀胱术的浸润性膀胱癌患者30例。对其临床资料进行回顾性分析和总结。结果 所有手术均获得成功,无中转开放,手术时间180～360 min(平均240 min),术中出血量150～450 ml(平均220 m1)。术后4～8d恢复肠道正常蠕动功能,随访时间6～60个月,中位随访时间26个月。30例术后均能恢复较满意的控尿功能,平均膀胱容量约398ml,平均夜尿1～3次;1例出现夜间遗尿; 2例出现尿漏;膀胱镜检查无尿道肿瘤复发;2例死于原发病转移。其余患者术后随访6个月血生化指标均正常,B超检查未见上尿路扩张积水。结论 腹腔镜下根治性全膀胱切除原位回肠新膀胱术具有创伤小、出血少、盆腔淋巴结清扫彻底、术后恢复快．术后控尿满意等优点,是治疗浸润性膀胱癌的一种理想手术方式。     

膀胱肿瘤膀胱切除及尿流改道13年总结(附56例报告)

目的 评价膀胱切除治疗膀胱癌的疗效及四种不同方式尿流改道的远期效果。方法 回顾分析1992年至2004年膀胱癌行膀胱切除及尿流改道术56例临床资料。结果 随访1—10年，5年生存率58．8％，生存超过10年者1例，大部分患者对正位可控肠代膀胱控尿满意。结论 膀胱切除并不能提高5年生存率，对部分浸润性膀胱癌可选择地采用保留膀胱手术；正位可控回肠膀胱术是最理想的尿流改道方式。     

Ileal conduit in era of systemic chemotherapy

The records of 62 patients with invasive transitional cell carcinoma of the bladder whose planned treatment was radical cystectomy with ileal conduit urinary diversion and postoperative systemic chemotherapy were reviewed. Seven of the patients received radical cystectomy but not postoperative chemotherapy as planned, 3 of them (5%) for reasons directly related to complications from the urinary diversion. Fifty-five patients received the planned postoperative chemotherapy. Complications during chemotherapy that were related to the ileal conduit were urinary tract infection in 37 percent and stenosis at the ureteroileal anastomosis requiring percutaneous nephrostomy in 3.6 percent. Chemotherapy was not discontinued in any patient, however, because of complications specifically related to the urinary diversion. We conclude that the ileal conduit is well tolerated by patients who require systemic chemotherapy and is, today, the simplest, safest, and best diversion method when systemic chemotherapy is to follow radical cystoprostatectomy.     

A case of late recurrence of urothelial carcinoma in an ileal conduit after radical cystectomy and ileal conduit diversion for bladder cancer

Recurrence of urothelial cancer in an ileal conduit after radical cystectomy is rare. A 79-year-old man suffered bladder cancer (UC cTisN0M0 G2＞3) and underwent total cystectomy with ileal conduit. He had recurrence of the right renal pelvis carcinoma 6 years after the total cystectomy, and was treated by right radical nephroureterectomy (pT3 G2＝3). The patient had another episode of recurrence in the ileal conduit 13 years after the initial operation. The entire ileal conduit (UC, G3, ew (-)) was resected and left cutaneous ureterostomy was performed. This case suggests that long-term follow-up is necessary after radical cystectomy and ileal conduit for urinary diversion.     

腹腔镜根治性膀胱切除术治疗肌层浸润性膀胱癌(附21例报告)

目的:探讨腹腔镜根治性膀胱切除术治疗肌层浸润性膀胱癌的初步经验,评价此术式的可行性及临床疗效。方法:回顾分析21例肌层浸润性膀胱癌患者行腹腔镜根治性膀胱切除术的临床资料,患者均行腹腔镜下标准盆腔淋巴结清扫、根治性膀胱切除术及尿流改道术,包括11例Bricker回肠膀胱术,4例输尿管皮肤造口术,6例Studer原位新膀胱术。观察手术时间、术中出血量、术后肠道功能恢复时间、术后并发症及手术疗效。结果:21例手术均获成功。手术时间平均(390±46.2)min,术中出血量平均(270±101.1)ml,1例输浓缩红细胞2个单位。术后3~5 d恢复肠蠕动。术后并发症发生率19.0%(4/21)。平均随访(12±5.5)个月,总生存率85.7%(18/21),1例死于肿瘤远处转移,2例死于心脑血管疾病。结论:腹腔镜根治性膀胱切除术具有患者创伤小、出血少、术后康复快等优点,是治疗肌层浸润性膀胱癌安全、有效、可行的方法。具备开放根治性切除术的手术经验及腹腔镜技术熟练的医院可尝试开展。初期开展,Bricker回肠膀胱术可作为首选的尿流改道术式。     

Is adjuvant chemotherapy for bladder cancer safer in patients with an ileal conduit than a neobladder?

OBJECTIVE: To assess the safety of adjuvant chemotherapy in patients with neobladder reconstruction in comparison to ileal conduit, as radical cystectomy and urinary diversion is an effective curative surgical treatment for muscle-invasive and high-risk superficial bladder cancer, and adjuvant chemotherapy is usually considered for patients with clinical stage > T2 and nodal metastasis. PATIENTS AND METHODS: We analysed retrospectively patients who had had a radical cystectomy and urinary diversion between 1992 and 2004. Patients with high-risk disease who had adjuvant chemotherapy were identified and stratified based on the type of urinary diversion (ileal conduit or neobladder). The chemotherapy regimen, complications from the adjuvant chemotherapy and other relevant data were analysed. RESULTS: Overall, 343 patients had radical cystectomy, 40 had adjuvant chemotherapy; 25 had an ileal conduit and 15 had a neobladder. Patient characteristics including age, stage and follow-up were similar. In all, 55% of patients had grade 1 toxicity, 23% grade 2, 18% grade 3, and 13% grade 4. No patients had serious organ toxicity and none died. There were no significant differences in the toxicity among the two groups. CONCLUSIONS: Adjuvant chemotherapy appears to be safe in patients with a neobladder and equally safe in patients with an ileal conduit. Hence neobladder reconstruction should not be denied to patients with bladder cancer who are at high risk of recurrence and who might require adjuvant chemotherapy.     

The anterior ileal conduit: results of 100 consecutive cases

PURPOSE: The ileal conduit of Bricker is still widely used for urinary diversion after radical cystectomy for bladder carcinoma. We have modified the standard technique with the aim of reducing the complication rate and facilitating treatment. MATERIALS AND METHODS: We leave the conduit in its natural isoperistaltic anterior position, the ureters are anastomosed in an anterior position on their own side, using a short ileum segment. The incision of the peritoneum is made in a particular manner to allow on its closure to extraperitonealize the anastomoses and the bottom of the conduit and to support and fasten the loop. RESULTS: A total of 100 consecutive patients after radical cystectomy for bladder cancer had anterior ileal conduit. The complication rates were 5% temporary ureteroileal leakage, 1% reoperation rate, 5% long-term stenoses and 3% renal function deterioration. The surgical revision and the treatment of ureteroileal stenoses with anterograde percutaneous ureteral stenting were not complicated procedures. A comparison with conventional Bricker series shows a significant decrease in the complication rate. CONCLUSIONS: The anterior ileal conduit reduces the technique complication rate and facilitates the treatment of complications, and it is a recommended operation for these reasons.     

Robot-assisted radical cystectomy in women: technique and initial experience

BACKGROUND AND PURPOSE: Robot-assisted radical cystectomy (RARC) is a new management option for the treatment of bladder cancer. This study evaluates an initial experience with RARC with ileal conduit diversion in women. PATIENTS AND METHODS: Twenty patients underwent RARC with ileal conduit urinary diversion, including four women, and our surgical technique is described here. A retrospective chart review was performed to evaluate clinical stage, tumor grade, operative times, estimated blood loss (EBL), pathologic stage, lymph node pathology, and complications. RESULTS: Mean patient age was 69.5 years, median operative time was 350 minutes, and median EBL was 300 mL. Median length of stay was 5 days, with the two most recent patients leaving by postoperative day 3. The median number of lymph nodes removed was 12, with one patient revealing node-positive disease. Surgical margins were negative for disease in all patients. No patients required blood transfusion or had major complications. CONCLUSION: RARC is a new technique available for the treatment of high-risk or invasive bladder cancer in women. This surgery provides decreased morbidity while maintaining the oncologic goals of traditional radical cystectomy.     

Utility of robot‐assisted radical cystectomy with intracorporeal urinary diversion for muscle‐invasive bladder cancer

Radical cystectomy remains the gold standard for treatment of muscle‐invasive bladder cancer. Robot‐assisted radical cystectomy has technical advantages over laparoscopic radical cystectomy and has emerged as an alternative to open radical cystectomy. Despite the advancements in robotic surgery, experience with total intracorporeal reconstruction of urinary diversion remains limited. Most surgeons have carried out the hybrid approach of robot‐assisted radical cystectomy and extracorporeal reconstruction of urinary diversion, as intracorporeal reconstruction of urinary diversion remains technically challenging. However, intracorporeal reconstruction of urinary diversion might potentially proffer additional benefits, such as decreased fluid loss, reduction in estimated blood loss and a quicker return of bowel function. The adoption of intracorporeal ileal neobladder reconstruction has hitherto been limited to high‐volume academic institutions. In the present review, we compare the totally intracorporeal robot‐assisted radical cystectomy approach with open radical cystectomy and robot‐assisted radical cystectomy + extracorporeal reconstruction of urinary diversion in muscle‐invasive bladder cancer patients.