改良单孔腹腔镜下膀胱前列腺根治性切除-原位回肠新膀胱术应用分析

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.

Application of modified single port laparoscopic radical cystoprostatectomy and orthotopic ileal neobiadder

Objective To evaluated the feasibility and therapeutic effect of laparoscopic-endoscopic single-site surgery (LESS) for radical cystoprostatectomy and orthotopic ileal neobladder.Methods Between November 2008 and August 2009,8 male patients with bladder cancer underwent modified single port laparoscopic cystoprostatectomy and orthotopic ileal neobladder with a home-made muhichannel port made up of two stretchable rings and a surgical glove with trocars and valves attached to its fingers.A 4-5 cm midline incision was made in lower abdomen and the muhichannel port placed into this incision.Laparoscopic instrument was extended through the multichannel port.Another port Was placed at the umbilicus site for laparoscope.The investigators performed the modified single port transperitoneal technique with bilateral extended lymphadenectomy,laparoscopic radical cystoprostatectomy,construction of ileal neobladder extracorporeally and urethro-pouch anastomosis under laparoscopy with a slipknot running suture technique.The perioperative and postoperative data were collected and analyzed prospectively.Results In all cases,no conversion into conventional laparoscopic or open surgery was necessary.The mean operative duration,including extended lymph node dissection,was 399 min (range:355-455 min).Mean estimated blood loss Was 154 ml (range:90-210 ml).The mean postoperative hospital stay WaS 15 d (range:14-18 d).No peri-operative mortality was reported.One case had delirium 2 days postoperatively and there was no port-related complication.The pathological report confirmed surgical margins were tumor-free for all cases.The average number of removed lymph node was 20.The mean follow-up period was 6.1 months (range:2.0-10.0 months).All patients remained disease-free until the last follow-up.Conclusions With a reduction of 4 ports,modified single port laparoscopic radical cystectomy with orthotopic ileal neobladder is technically feasible with a low complication rate.Our initial outcome is encouraging,but additional work and a further follow-up are warranted to critically compare the oncological outcome with open surgery.