男性膀胱癌根治性膀胱切除术的技术改进(附62例报告)

目的:改进男性膀胱癌根治性膀胱切除术的手术技术,减少并发症。方法:改进根治性膀胱切除术,包括顺逆性结合的膀胱前列腺切除、输尿管远端冰冻活检、缝扎背深静脉、保护神经血管束、广泛盆腔淋巴结清扫等。对62例患者临床资料进行回顾性分析。结果:患者平均年龄67岁,膀胱前列腺切除及淋巴清扫的手术时间2.2~3.5h,平均2.5h。术中出血量150~1200ml,平均400ml。62例中7例(11.3%)术中冷冻切片证实输尿管残端有肿瘤细胞浸润或上皮细胞不典型增生。切除淋巴结8~16枚/例,阳性率16.1%(10/62)。本组术后6例有轻度肠梗阻,对症治疗好转;1例切口部分脂肪液化,无肺、盆腔感染,无直肠损伤等并发症,无一例围手术期死亡。随访3~52个月,1例术后5个月骨转移死亡,余均未发现盆腔、吻合口及其他脏器的远处转移。有意保留神经血管束的10例,其中4例有勃起功能;无意保留神经血管束,术后有勃起功能者3例(随访30例)。结论:改进的根治性膀胱切除术可有效根治性切除肿瘤,可减少术中后出血,降低并发症发生率。

Technical improvements in radical cystectomy in the male(Report of 62 cases)

Objective:To evaluate the effect of technical improvements of radical cystectomy in the male.Methods:Technical improvements included cystectomy with direct and antidromic method,frost section of the distal end of ureter,protection of the neurovascular bundle,extended radical lymphadenectomy,suture and ligation of the dorsal vein complex.Clinical data of 62 patients with bladder cancer were analyse retrospectively.Results:The mean operative time was 2.5 h.The mean blood loss was 400 ml.There were 11.3% cases demonstrated positive end of ureters.Each patient had 8~12 lymphnode resected and tumor positive rate was 16.1%.There were 6 cases in this group developed incomplete ileus,and became ameliorative with preserved treatments.One case took place fat fluidify,no patients had complications of infection of lung and pelvis,as well as rectum damage.Following up 3~52 months,one patient died of bone metastasis and none were founded having metastasis at anastomosed sitet and other organ.There were 4 patients had erectile function among 10 cases whose neurovascular bundle were deliberately protected.However,only three patients had erectile function among 30 cases whose neruvascular bundle were protected unconsciously.Conclusions:Improved radical cystectomy is feasible,and it can reduce blood loss prevent complications.