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1.
目的尝试完成经尿道途径辅助下单孔腹腔镜猪全膀胱切除加回肠代膀胱术,探讨该操作的可行性,总结操作经验。方法体质量约为30kg的雌性香猪,全麻后仰卧位,平脐水平,经右侧腹直肌纵行切开2cm长皮肤切口,钝性分开腹直肌并切开腹膜。置入SILS单孔多通道平台后,建立气腹。超声刀配合可弯分离钳游离膀胱周围组织,并离断双侧输尿管。末端可弯电钩离断尿道,完成膀胱切除。在输尿管镜的引导下,经尿道置入12mm的普通腹腔镜套管。选择合适肠管后,经尿道套管置入直线切割器进行离断。单孔腹腔镜下完成小肠侧侧吻合和左侧输尿管小肠吻合。经尿道套管取出膀胱标本,缝闭尿道残端。取出SILS单孔多通道平台,一并将右侧输尿管及拟行造口的小肠输出袢带出。体外完成右侧输尿管和输出袢吻合,并将小肠黏膜外翻完成造口。结果完成3例动物试验,手术时间210~335min,平均(275±63)min,未增加额外套管。术毕,腹壁除正常肠造口外,无其他手术切口。结论经尿道途径辅助下有利于完成高难度的单孔腹腔镜猪全膀胱切除加回肠代膀胱重建术,但手术操作难度较大。  相似文献   

2.
目的 观察单孔腹腔镜-内镜手术在膀胱前列腺根治性切除-原位回肠新膀胱术中的可行性及治疗效果.方法 对2008年11月至2009年8月收治的8例男性膀胱癌患者采用自制多通道套管进行改良单孔腹腔镜下膀胱前列腺根治性切除-原位回肠新膀胱术.多通道套管由2个胶圈和1个外科手套构成,手套手指连接着2个穿刺套管和2个活瓣圈,多通道套管经下腹部正中小切口置入,腹腔镜器械经该套管置入进行操作.另经脐上置入1个套管用于放置腹腔镜,依次行腹腔镜下双侧扩大盆腔淋巴结清扫、膀胱前列腺根治性切除、体外构建回肠新膀胱及腹腔镜下新膀胱尿道吻合术.收集围手术期及术后资料并进行分析.结果 所有患者手术均顺利完成,无一例中转常规腹腔镜手术或开放手术.平均手术时间为399 min(355-455 min),平均出血量为154 ml(90~210 ml),平均术后住院时间为15 d(14-18 d).其中1例患者术后出现谵妄,经保守治疗恢复正常.无一例发生操作通道相关并发症.术后病理示所有病例手术标本切缘均为阴性,平均清扫淋巴结20个.患者平均随访6.1个月(2.0~10.0个月),未发现肿瘤复发、转移.结论 改良单孔腹腔镜下膀胱前列腺根治性切除-原位回肠新膀胱术技术上可行,减少了4个手术套管,手术并发症发生率低,短期随诊肿瘤控制效果好,长期根治效果尚待观察.  相似文献   

3.
目的 :评价经尿道途径辅助下经脐单孔腹腔镜根治性全膀胱切除术的可行性及其优势。方法 :2014年10~12月,2例男性膀胱癌患者采用多通道套管,在经尿道途径辅助下,行经脐单孔腹腔镜根治性全膀胱切除、双侧盆腔淋巴结清扫及单乳头双输尿管一侧腹壁造口术。操作全部在单孔腹腔镜下进行。收集围手术期及术后资料进行分析。结果:2例手术均顺利完成,无中转常规腹腔镜或开放手术。单孔平均手术时间为4.15 h。术中平均出血量为150 ml,平均术后住院时间为15 d。围手术期内无严重并发症发生。术后病理示2例手术标本切缘均为阴性,平均清扫淋巴结16.5个,前者3/15阳性,后者0/18阳性。结论:经尿道辅助的经脐单孔腹腔镜行全膀胱根治性切除术安全可行。该术式减少了腹腔镜与操作器械之间的相互干扰,降低了手术难度和风险,手术并发症发生率低。  相似文献   

4.
目的 探讨经耻骨后 会阴联合切口行根治性前列腺切除术后尿道重建新方法的优缺点。方法 对 6例前列腺癌患者采用经耻骨后 会阴联合切口行前列腺癌根治性切除及后尿道重建术式 ,术中常规行耻骨后前列腺根治性切除后 ,另经会阴部切口游离 4~ 6cm残余尿道 ,将其拉入盆腔与膀胱颈部吻合。结果 术后留置尿管 14~2 8天 ,平均 2 1 6天。随访 2~ 17个月 ,平均 7 3月 ,5例排尿通畅 ,控尿能力良好 ,无尿失禁发生。1例术后 1个月内会阴部伤口感染 ,拔除尿管后排尿困难 ,现仍定期行尿道扩张中。结论 经耻骨后 会阴联合切口行根治性前列腺切除术及后尿道重建的新方法可使吻合口处显露良好 ,吻合张力低 ,粘膜对合整齐 ,可明显降低术后尿失禁及尿道狭窄发生率。但其远期疗效尚需大量病例的长期随访观察。  相似文献   

5.
目的 探索达芬奇机器人手术在泌尿外科应用的安全性和有效性.方法 回顾性分析我院2014年1月至2015年4月采用达芬奇机器人辅助腹腔镜手术治疗16例泌尿外科患者的临床资料.结果 16例手术全部成功,包括肾部分切除术3例、肾根治性切除术2例、前列腺根治性切除术6例、膀胱根治性切除及回肠膀胱术4例、膀胱根治性切除及输尿管皮肤造瘘术1例.3例肾部分切除患者、2例肾根治性切除患者、1例膀胱根治性切除及输尿管皮肤造瘘患者和6例前列腺根治性切除患者的平均手术时间及出血量相当,但4例膀胱根治性切除及回肠膀胱术患者的手术时间及出血量较多,分别为(436.3±16.8) min及(325.0±95.7) ml.所有患者的手术过程顺利,无中转开放手术、无围手术期并发症.结论 机器人手术在泌尿外科应用是安全有效的,尤其适用于狭窄盆腔手术及功能重建手术.  相似文献   

6.
腹腔镜下膀胱根治性切除-原位回肠新膀胱术108例分析   总被引:3,自引:1,他引:3  
目的 报道108例腹腔镜下膀胱根治性切除-原位回肠新膀胱术手术资料及术后并发症、性功能、控尿功能和肿瘤根治情况.方法 2002年12月至2007年5月,108例膀胱癌患者施行了腹腔镜下膀胱根治性切除-原位回肠新膀胱术,其中男96例,女12例.采用5孔经腹入路,首先进行完全腹腔镜下标准的双侧盆腔淋巴结清扫及根治性膀胱切除,然后行体外回肠新膀胱的构建和输尿管新膀胱吻合,最后在腹腔镜下进行新膀胱尿道吻合,其中26例患者施行保留勃起神经步骤.结果 平均手术时间为330 min,出血量为320 ml,无中转开放手术.无围手术期死亡,手术并发症发生率为18.5%,所有患者手术切缘均为阴性.术后6个月日间尿控率90.7%,夜间尿控率82.6%.术后6个月,26例行保留勃起神经患者中10例有性功能.术后随访1~53个月,局部肿瘤复发5例,套管穿刺口种植转移1例,远处转移6例,随访期间死亡11例.结论 腹腔镜下膀胱根治性切除-原位回肠新膀胱术是可行的,具有低并发症和较好的新膀胱功能.  相似文献   

7.
目的探讨腹腔镜前列腺癌根治术后吻合口尿漏的防治方法。方法自2006年1月至2011年1月,我院行腹腔镜前列腺癌根治术151例,其中采取双针连续尿道膀胱吻合法58例、传统尿道膀胱缝合法93例。出现持续性尿道膀胱吻合口尿漏8例(5.3%,8/151),平均年龄66(53~78)岁;术前总前列腺特异抗原(T-PSA)平均34.3(1.1~165.0)ng/ml;Gleason评分<7分4例、7分2例、>7分2例;TNM T1c5例、T2a2例、T2c1例;平均手术时间202(60~360)min;均采用调整导尿管位置、持续低张力牵拉导尿管,并保持导尿管、耻骨后引流管通畅,预防感染、减少液体摄入量,同时加强营养等保守处理方法。保守治疗失败的病例,行腹腔镜下吻合口尿漏修补。结果采取双针连续尿道膀胱吻合法的病例,均未出现持续性吻合口尿漏,明显优于传统法缝合组[0vs 8.6%(8/93),P<0.05]。6例经保守处理治愈,2例行腹腔镜下吻合口尿漏修补治愈。平均33(21~43)d拔除导尿管,术后平均随访39(22~60)个月,无尿道狭窄发生。结论采取双针连续尿道膀胱吻合法可以有效防止吻合口尿漏的发生,保守治疗、腹腔镜下修补是处理术后持续性吻合口尿漏的有效方法。  相似文献   

8.
目的:探讨腹腔镜根治性膀胱切除术的临床价值。方法:对具有手术指征的15例膀胱癌患者施行腹腔镜根治性膀胱切除术治疗。常规建立5个工作通道,在腹腔镜下行双侧盆腔淋巴结清扫及膀胱全切除,自下腹切口取出标本。4例行回肠膀胱术,11例行原位回肠新膀胱术。观察手术时间、术中出血量、输血量、术后肠道功能恢复、尿外渗、尿瘘及术后腹腔并发症发生以及手术后效果。结果:15例手术成功。腹腔镜下根治性膀胱切除手术时间150~300 min;腹腔镜下新膀胱与后尿道吻合手术时间30~100 min;手术总时间300~660 min,术中出血500~1 200 mL;术中输血0~800 mL。2例术后出现急迫性尿失禁,经锻练后控尿满意;其余患者恢复良好。无腹腔并发症发生。结论:腹腔镜根治性膀胱切除术具有创伤小、术中操作精细、盆腔淋巴结清扫彻底、术后恢复快、并发症少的优点。  相似文献   

9.
目的 探讨腹腔镜下根治性膀胱切除回肠通道术的术式.方法 浸润性膀胱癌患者8例,男性6例,女性2例,年龄59-75岁,平均年龄67岁.腹腔镜下根治性膀胱切除,下腹正中4~5cm切口取出标本,行回肠通道术.结果 手术时间5~7h,平均5.5h,其中腹腔镜下操作时间190~260min,平均215min.出血量200~400ml,平均260ml.均未出现围手术期并发症,术后随访1~16个月,1例患者术后1个月复查发现输尿管吻合口狭窄,其余患者肾功能均正常,IVU检查未发现输尿管回肠吻合口狭窄或输尿管返流.结论 腹腔镜下膀胱根治性切除回肠通道术创伤小、手术时间短、恢复快,是膀胱全切除中的对于老年患者适合开展的术式.  相似文献   

10.
目的对尿道途径辅助下经脐单孔腹腔镜根治性前列腺切除术的临床效果予以分析和探讨。方法将2014年1月至2015年12月期间于我院进行治疗的膀胱癌患者8例进行回顾性分析,所有患者均通过尿道途径辅助下经脐单孔腹腔镜根治性前列腺切除术进行治疗,对手术时间、术中出血量、不良反应等进行观察和记录。结果 8例患者经过手术治疗后,均取得了手术成功,手术时间平均(167.3±6.9)min,术中出血量平均为(123.4±5.1)ml,有1例发生了直肠周围组织的损伤。结论尿道途径辅助下经脐单孔腹腔镜根治性前列腺切除术是一种安全性高,不良反应发生率低,治疗效果显著的治疗方法,降低了手术的难度与风险,值得我们在临床上进一步的推广和使用。  相似文献   

11.
Abstract: Background: Laparoendoscopic single-site surgery radical prostatectomy (LESS-RP) is a challenging urological procedure and needs to be further evaluated. This study was to illustrate the safety and initial results of pure LESS-RP with conventional available instruments. Methods: A prospective clinical database was established in September 2010 to assess the outcome following the introduction of LESS-RP at our institution. By August 2012, six procedures had been performed. The mean patient age was 74.7 (74-76 yrs.). The mean BMI was 23.8 (19.5-32.2 kg/m2). The LESS-RP was preformed through an extra-peritoneal approach by using single port access with QudaPort, 0o lens 5mm flexible tip video-laparoscope and conventional available laparoscopic instruments. Parameters assessed were operative time, estimated blood loss, intraoperative complications, drainage time, post-operative pain score (VAPS, 0-10), pathological results and post-operative PSA levels. Results: LESS-RP was completed for all six cases without additional trocar placement or conversion to standard laparoscopic or open radical prostatectomy. The mean operative times were 252.5 (190-305 min), estimated blood loss was 300 (100-500 ml). There was no documentable intraoperative complication. The wound-drainage time was a mean 5.2 (2-7 d), and the first post-operative day VAPS was 0.83 (0-3). Final pathological staging was pT2aN0M0 in 4 cases and pT2cN0M0 in 2 cases. Surgical margins were negative for all cases. The one-month post-operative PSA was less than 0.02 ng/ml in each case. All patients were continent without pad usage at one year post-operatively. Conclusion: The technique of pure LESS-RP is feasible and early outcomes are acceptable.  相似文献   

12.
目的:旨在减轻病人痛苦,减少前列腺摘除术后并发症的发生。方法:我们将50例耻骨上经膀胱前列腺摘除术后病人随机分为两组,A组25例术后采用镇痛泵处理,B组25例术后采用硬膜外间断给药。结果:镇痛效果、病人术后恢复A组均优于B组。结论:镇痛泵的应用是减少耻骨上经膀胱前列腺摘除术后疼痛及合并症的有效方法之一。  相似文献   

13.
Laparoscopic radical prostatectomy is considered the first treatment of choice for local prostate cancer due to its minimal invasion advantage. To further achieve the goal of minimal invasion, single port laparoscopic radical prostatectomy has been developed to minimize the complications associated with puncture tracks. The aim of this study was to illustrate the technique for single port laparoscopic radical prostatectomy and evaluate its efficacy and safety. We reported 8 cases of radical prostatectomy with excellent early outcome carried out in Shanghai Changzheng Hospital from June 2009 to August 2009 using a home-made multiple instrument access port and adding an additional small incision at McBurney point.
  相似文献   

14.
Background  Laparoendoscopic single-site surgery (LESS) approaches have been reported for treating various kidney and pelvic procedures, and are feasible and effective in selected patients. In this study, we aimed to present the initial experience and evaluate the efficacy of laparoscopic radical prostatectomy performed through a single incision using a multichannel port.
Methods  Between July 2010 and April 2011, six patients diagnosed with early stage prostate cancer underwent LESS radical prostatectomy (RP) in our institute. A multichannel port was inserted transperitoneally through a 2-cm umbilical incision. Specially articulating and flexible laparoscopic were used. Some technical tricks and points were applied during the operation to overcome the drawbacks and reduce the difficulties of this approach. Two continuous urethrovesical sutures in both sides were performed to complete both lateral aspects of anastomosis. The two ends of the suture threads were fixed by double Lapro-Clips, instead of the difficult knot-tying.
Results  Total operative time was (265±43) minutes. Mean blood loss was (230±65) ml. All cases were completed successfully, without conversion to open surgery or adding additional abdomen ports. No patient required a blood transfusion and no intraoperative complications occurred. The Foley catheter was removed at the 14th day (range 12th–16th) after surgery. At the 12th week of follow-up, all patients had an undetectable prostate-specific antigen level. Two patients used 2 or 1 pad for continence daily; other patients had achieved good continence.
Conclusion  In selected cases, LESS-RP is feasible and effective; these technic points and the flexible-articulating instruments are helpful to reduce the operation difficulties.
  相似文献   

15.
目的总结单切口腹腔镜前列腺癌根治术治疗早期局灶性前列腺癌的手术经验。方法2009年6月至8月,我科对5例早期局灶性前列腺癌患者实施单切口腹腔镜前列腺癌根治术。手术采用经腹膜外入路,取脐下约3cm长切口,使用自制Port,插入1枚10mm TROCAR及2枚5mm TROCAR,游离并切除前列腺,吻合膀胱尿道。结果5例腹腔镜前列腺癌根治术均获成功,无一例中转开放手术或传统腹腔镜手术。手术时间135~210min,平均(167±31.5)min;其中前列腺切除用时90~150min,平均(115±26)min,尿道膀胱吻合用时45~60min,平均(52±5.7)min。术中出血量50~200ml,平均(90±62)ml;标本切缘阳性1例。术后1周拔除导尿管,出现短暂尿失禁2例。术后随访4~12周,前列腺特异抗原(PSA)均<0.2μg/L。结论单切口前列腺癌根治术是安全可行的,熟练的腔镜手术技巧和特殊的Port及可弯曲器械是手术成功的关键。  相似文献   

16.
OBJECTIVE: To summarise our experience of laparoscopic radical prostatectomy in a single centre in Hong Kong over 5 years. DESIGN: Retrospective study. SETTING: Urology Division, Department of Surgery, Tuen Mun Hospital, Hong Kong. PATIENTS: A total of 87 patients who underwent laparoscopic radical prostatectomy from March 2002 to May 2007. MAIN OUTCOME MEASURES: Peri-operative data and follow-up information. RESULTS: The operative procedure used entailed Montsouris technique and its modifications, including the latest method involving the extraperitoneal descending technique. In all, 87 patients underwent the operation; in two, the procedure was converted to open surgery. Peri-operative parameters which showed improvement included: operating time, blood loss, resort to blood transfusions, and the complication rate. There was no operation-related mortality. In organ-confined disease, a clear surgical margin was achieved in 93% of the patients, but in those whose disease was not organ-confined, the positive margin rate was 87%. Among patients with organ-confined disease, 13% had evidence of biochemical recurrence. Hormonal therapy was started in five patients, none of whom died during the follow-up period (mean, 24 months). Continence recovered in 69% of the patients by 6 months and in 92% by 12 months post-surgery. Assessment of erectile function before and after the surgery was problematic and estimated to be 20% among patients having the nerve-sparing procedure performed. CONCLUSION: Although Hong Kong has a relatively low incidence for prostate cancer, it was possible to develop laparoscopic radical prostatectomy with acceptable early results. Further follow-up is warranted before formulating definitive conclusions about this procedure.  相似文献   

17.
目的:探讨经腹腔镜行前列腺癌根治术的控尿技术手术配合方法。方法:对180例前列腺癌患者实施经腹腔镜行前列腺癌根治术保留控尿功能。充分做好术前准备,术中巡回护士与器械护士默契配合,做好体位护理,密切观察病情变化,准确传递手术器械。结果:180例患者手术均获成功,平均手术时间为3.9h,平均出血量为340ml。结论:控尿技术在经腹腔镜行前列腺癌根治术中创伤小、出血少、恢复快、减少了手术并发症,娴熟、准确的手术配合是确保手术成功的关键。  相似文献   

18.
正肺癌是目前我国发病率及死亡率最高的恶性肿瘤之一,随着低剂量胸部CT的普及,肺部小结节在人群中的发现率越来越高,所筛查到的肺癌分级、分期也呈现越来越早期的趋势,因此,治疗策略也需要有所改变。目前,胸腔镜下亚肺叶切除术(包括肺叶楔形切除术及肺段切除术)是针对肺部结节为主的  相似文献   

19.
腹腔镜外科手术的发展已有几十年的历史,腹腔镜技术将传统的开放性手术引入了微创时代.随着腹腔镜器械及技术研究的进步,现在许多大型、复杂的手术能够轻松地在腹腔镜下完成,如腹腔镜肾切除术、腹腔镜肾部分切除术、腹腔镜前列腺癌根治术、腹腔镜膀胱全切术等,国内外众多的文献及研究表明,腹腔镜手术较传统的开放性手术具有明显的优势,本文就近年的相关研究做一综述.  相似文献   

20.
CONTEXT: Patients with prostate cancer and their physicians need knowledge of treatment options and their potential complications, but limited data on complications are available in unselected population-based cohorts of patients. OBJECTIVE: To measure changes in urinary and sexual function in men who have undergone radical prostatectomy for clinically localized prostate cancer. DESIGN: The Prostate Cancer Outcomes Study, a population-based longitudinal cohort study with up to 24 months of follow-up. SETTING: Population-based cancer registries in 6 geographic regions of the United States. PARTICIPANTS: A total of 1291 black, white, and Hispanic men aged 39 to 79 years who were diagnosed as having primary prostate cancer between October 1, 1994, and October 31, 1995, and who underwent radical prostatectomy within 6 months of diagnosis for clinically localized disease. MAIN OUTCOME MEASURES: Distribution of and change in urinary and sexual function measures reported by patients at baseline and 6, 12, and 24 months after diagnosis. RESULTS: At 18 or more months following radical prostatectomy, 8.4% of men were incontinent and 59.9% were impotent. Among men who were potent before surgery, the proportion of men reporting impotence at 18 or more months after surgery varied according to whether the procedure was nerve sparing (65.6% of non-nerve-sparing, 58.6% of unilateral, and 56.0% of bilateral nerve-sparing). At 18 or more months after surgery, 41.9% reported that their sexual performance was a moderate-to-large problem. Both sexual and urinary function varied by age (39.0% of men aged <60 years vs 15.3 %-21.7% of older men were potent at > or =18 months [P<.001]; 13.8% of men aged 75-79 years vs 0.7%-3.6% of younger men experienced the highest level of incontinence at > or =18 months [P = .03]), and sexual function also varied by race (38.4% of black men reported firm erections at > or =18 months vs 25.9% of Hispanic and 21.3% of white men; P = .001). CONCLUSIONS: Our study suggests that radical prostatectomy is associated with significant erectile dysfunction and some decline in urinary function. These results may be particularly helpful to community-based physicians and their patients with prostate cancer who face difficult treatment decisions.  相似文献   

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