腹腔镜下根治性全膀胱切除原位回肠代膀胱术（附22例报道）

目的：探讨腹腔镜下根治性全膀胱切除原位回肠代膀胱术的手术方法及临床疗效。方法：浸润性膀胱癌患者22例，男16例，女6例，年龄63（51～74）岁。5个套管针法先行腹腔镜手术：游离输尿管后分侧清扫盆腔淋巴结；男性患者切除膀胱及前列腺，标本通过腹壁小切口取出；女性患者切除膀胱、子宫及双附件，标本经阴道取出。原位回肠代膀胱术：下腹正中4～8cm切口，将回肠拉出切口外，游离40～50cm回肠，剖开后W形折叠缝合形成贮尿囊；插入法植入双侧输尿管。16例患者在直视下进行新膀胱尿道吻合。6例缝合腹壁切口后重新开启气腹，腔镜下行新膀胱尿道吻合。结果：手术全部取得成功，无中转开腹者。手术时间4．5～9h，平均6．3h；出血量400-1200ml，平均529ml。术后1～3个月所有患者均恢复较满意的控尿功能。新膀胱平均最大容量约398ml。结论：腹腔镜下根治性全膀胱切除原位回肠代膀胱术是治愈浸润性膀胱癌可行而有效的微创手术方法。

Laparoscopic Radical Cystectomy with Orthotopic Ileal Neobladder(Report of 22 Cases)

Objective： To present the surgical methods and clinical efficacy of laparoscopic radical cystectomy （LRC） with orthotopie ileal neobladder. Methods： 22 patients （16 male, 6 female） with invasive bladder carcinoma underwent laparoscopie radical cystectomy with orthotopie ileal neobladder. The mean age was 63 years （ range 51 to 74 years）. With 5 troears, the bilateral pelvic lymphadenectomy were performed first. After dissociating ureter, pelvic lymph node were rided up side by side. For male patients, the radical cystoprostateetomy was per formed and the entire specimen was removed through abdominal incision. For female, total bladder, uterus and ap pendage were dissected by the laparoscopically approach. The specimen was delivered through the incision of the anterior and posterior vaginal fornix apex and the neovagina was created by the transvaginal visualized suture. Or thotopie ileal neobladder： 4 - 8 cm incision in the middle of abdomen, the ileum were pull out the incision, and a 30 40 cm ileal loop was taken from the abdominal cavity, isolated, de-tuhularized and reconfigured into ‘W＇ shaped pouch with running suture. The anti refluxing ureter implantation was performed by inserting the 1 cm of ureter into the pouch and suturing them. The urethra neobaldder anastomosis was completed through the abdominal inci sion for 16 patients, while abdominal incision of 6 cases were sutured and re-open the pneumoperitoneum, the anastomosis of the new bladder and urethra were done under the laparoseope. Results： All the operations were successfully completed without conversion to open surgery. The mean duration of surgery was 4 to 9 h with a mean of 6.3 h. The blood loss was 400 to 1 200 ml with a mean of 529ml. All of patients achieved urine control and had neither obstruction nor reflux proved by the intravenous pyelography 1-3 months after surgery. The mean value of neobladder maximum capacity was 398 ml. Conclusions：The I.RC with orthotopic ileal neobladder is feasible and effective for the