腹腔镜下全膀胱切除术(附50例报告)

目的:探讨腹腔镜下全膀胱切除术的手术方法和临床效果。方法:50例患者中男41例,女9例,52～76岁;经病理证实为浸润性膀胱移行细胞癌Ⅱ～Ⅲ级,TNM分期:T2N0M028例,T3aN0M014例,T3bN0M08例。行腹腔镜下全膀胱切除术,其中34例行原位乙状结肠代膀胱术,16例行输尿管造口术,观察手术时间,术中出血量,术后肠道功能恢复、并发症及手术效果。结果:手术时间5～10h,术中出血200～1000ml,术后约72h肠道功能恢复,术后2周拔输尿管导管,术后3周拔尿管后腹压排尿正常,术后3个月IVU未见肾积水,未发生腹腔并发症。结论:经腹腹腔镜全膀胱切除术,具有微创、出血少、恢复快等特点,随着技术的进步,该术式将成为治疗浸润性膀胱癌的较好方法之一。

Laparoscopic radical cystectomy for carcinoma of bladder:a report of 40 cases

Objective:To evaluate the surgical technique and clinical efficacy of laparoscopic radical cystectomy for bladder cancer.Methods:There were 41 male and 9 female,52-76 years old(mean 66.8 years).The pathological reports of 50 cases showed transitional cell carcinoma Ⅱ-Ⅲ grade;34 cases were performed laparoscopic radical cystectomy with reconstruction of bladder with sigmoid,16 cases were performed ureterostomy,and we recorded the operation time,the blood loss,the intestine function recovery time and the complication.Results:All operations were successful with the operation time 5-10h,the blood loss 200-1 000ml(mean 360ml).The intestine function recovered about 72h after operation.All ureteral catheters were removed 2 weeks after surgery.Urethral catheter was removed 3 weeks after surgery,the patients were able to urinate by abdominal pressure,and the IVU showed no abnormality 3 months after surgery.Conclusions:Laparoscopic radical cystectomy for invasive bladder cancer is a safe and efficient method,with advantages of good operating field,minimal invasion,less celiac complications,short hospital stay and rapid recovery.It is worth to be widespread.