世界首例单孔腹腔镜根治性膀胱切除、全去带乙状结肠原位新膀胱术

目的 报告世界首例单孔腹腔镜(LESS)根治性膀胱切除术,并采用全去带乙状结肠构建原位膀胱.方法 患者为74岁男性,因血尿2月人院,活检病理确诊为膀胱癌.行LESS根治性膀胱切除术,于下腹正中取3.5 cm纵形切口,置入单孔多通道套管(R-port)建立手术入路.手术过程包括双侧盆腔淋巴结清扫.根治性膀胱切除术完成后,开放构建全去带乙状结肠原位新膀胱.结果 手术总时间9.5 h,LESS部分5.5h.术中采用传统腹腔镜器械,没有增加其它通道,最终病理结果为尿路上皮癌.术中失血约600ml,输注红细胞400ml.清扫的盆腔淋巴结均为阴性.尿道及输尿管切缘未见肿瘤侵犯.围手术期未发生水电平衡紊乱及酸碱失衡.术后3月复查,未见肿瘤复发和远处转移,新膀胱容量约280ml.残余尿10ml,最大尿流率11.1 ml/s.结论 尽管LESs手术有着更长的学习曲线,但有望成为治疗浸润性膀胱肿瘤的更加微创更美观的手术方法.     

根治性膀胱全切去带乙状结肠原位新膀胱术的临床研究

目的:探讨根治性全膀胱切除、去带乙状结肠原位新膀胱的疗效和并发症的防治。方法:对26例膀胱癌患者用根治性膀胱全切除及去带乙状结肠原位新膀胱术治疗,对其疗效及并发症的防治进行分析。结果:疗效比较令人满意,并发症主要包括心血管、泌尿系统、消化系统等方面。结论:根治性全膀胱切除、去带乙状结肠原位新膀胱的疗效满意,具有较好的应用价值;加强围手术期护理,减少并发症,对提高手术疗效是至关重要的。     

全去带乙状结肠原位新膀胱术4例报告

目的:探讨全去带乙状结肠原位膀胱术的临床疗效及此术式对机体的影响.方法:膀胱移性上皮癌4例,均采用根治性膀胱切除及去带乙状结肠原位膀胱术治疗.结果:随访患者排尿功能良好.结论:该术式操作简单,并发症少,术后排尿、储尿功能确切,是一种较理想的尿路分流术.     

全去带乙状结肠原位新膀胱术134例随访

目的 评价全去带乙状结肠原位新膀胱术疗效.方法 对134例在我院施行根治性膀胱全切+全去带乙状结肠原位新膀胱术患者的临床资料、随访情况作统计分析;内容包括近期和远期并发症,控尿情况及尿流动力学评估,男性患者的勃起情况.结果 平均随访(39±14.2)个月.近期并发症47例(35.07%),其中15例(31.9%)需外科...     

全去带乙状结肠原位膀胱术9例临床分析

目的:总结去带乙状结肠原位膀胱术的临床经验。方法:回顾性分析我院2006-2010年间实施去带乙状结肠原位膀胱术患者的临床资料。结果:本组9例患者,7例术后能自主排尿,每次尿量约100～300ml,1例时有尿失禁,夜间遗尿,1例出现尿漏、肠漏,引流后治愈,能自主控尿,新膀胱容量300～700ml。结论:全去带乙状结肠新膀胱术操作简化,并发症少,有较高的实用价值。     

全去带乙状结肠原位新膀胱术134例随访报告

目的 评价全去带乙状结肠原位新膀胱术疗效。方法 对2000年2月至2009年10月134例在我院施行根治性膀胱全切+全去带乙状结肠原位新膀胱术患者的临床资料、随访情况作统计分析;内容包括近期和远期并发症,控尿情况及尿流动力学评估,男性患者的勃起情况。结果 平均随访39（3～117）个月。近期并发症47例（35.07%）,其中15例（31.9%）需外科手术干预。围手术期死亡率5.97%。晚期并发症39例（33.33%）,主要是新膀胱尿道吻合口狭窄（38.46%）和上尿路梗阻（28.21%）。日间控尿率89.74%,夜间控尿率58.97％,平均最大容量和最大压力 （221.7＋82.6）mL和（30.3＋14.9）cmH2O。平均最大尿流率（12.0＋5.8） mL/s。16例（30.19 %）术后恢复勃起功能。结论 全去带乙状结肠原位新膀胱术,操作简单,新膀胱功能良好,且在位置、形态及输尿管抗反流等方面接近正常膀胱,早、晚期并发症的发生率都可接受,并提供满意的控尿率。     

腹腔镜根治性膀胱切除及回肠原位新膀胱术（附9例报告）

目的总结腹腔镜根治性膀胱切除加回肠原位新膀胱术的经验。方法对9例膀胱癌患者施行腹腔镜根治性膀胱切除及回肠原位新膀胱术,采用完全腹腔镜下标准的双侧盆腔淋巴结清扫加根治性膀胱切除,然后体外行回肠新膀胱构建和输尿管新膀胱吻合,最后在腹腔镜下行新膀胱尿道吻合。结果9例手术均成功,无中转开腹,无围手术期死亡,平均手术时间为370min,平均出血量为650ml,所有患者手术切缘均为阴性。术后9例日间尿控均良好,2例存在夜间尿失禁。术后随访2—8个月,1例出现新膀胱腹壁瘘,1例发生新膀胱前假性尿液囊肿,2例出现肾盂肾炎。结论腹腔镜根治性膀胱切除加回肠原位新膀胱术具有切口小、损伤少、疼痛轻、出血少、术后恢复快等优势,将成为肌层浸润性膀胱癌的标准手术方式。     

腹腔镜下膀胱全切除原位乙状结肠代膀胱术(附12例报告)

目的:探讨腹腔镜下膀胱全切除原位乙状结肠代膀胱手术的方法与治疗效果。方法:对12例浸润性膀胱癌患者采用腹腔镜下全膀胱切除术,前列腺切除或子宫次全切除。经腹壁造口取出切除物,行乙状结肠去带原位新膀胱术。结果:12例手术成功,手术时间5~10 h,平均6.5 h;出血量200~1 000 ml,平均387 ml,代膀胱充盈良好,容量约300 ml,术后4~6周患者恢复控尿功能,无排尿困难及尿失禁。结论:腹腔镜下行膀胱全切除视野清晰,可减少出血,缩短手术时间。     

腹腔镜下全膀胱切除并去带乙状结肠新膀胱术（附26例报告）

OBJECTIVE: To review our experience with intracorporeal laparoscopic radical cystectomy and sigmoid colon orthotopic neobladder reconstruction. METHODS: The clinical data of 26 cases of bladder carcinoma treated with the indicated surgical procedures were reviewed. RESULTS: The surgeries were successful in all the cases with the operating time ranging from 240 to 390 min, blood loss of 400 to 800 ml and red-cell transfusion of 0-4 U. Oral food intake was allowed 4-8 days after the operation, ureteral stents were removed in weeks 3 to 8 and the pouch catheter was removed in week 4 postoperatively. Daytime urinary continence was excellent and urinary incontinence at night occurred in 8 patients 3 months after the operation. CONCLUSION: Sigmoid colon orthotopic neobladder reconstruction can be effective for urinary diversion to ensure good quality of life of the patients.     

根治性膀胱切除原位回肠新膀胱术研究进展

近年来,原位新膀胱手术（Orthotopic Neobladder）迅速发展,在原位新膀胱选材时既要充分考虑到材料对患者机体生理影响,又要考虑新膀胱功能的情况。目前,临床上最常用的原位回肠新膀胱术式有Studer、Hautmann、半Kock新膀胱、T型回肠新膀胱。原位新膀胱相比于其他尿流改道术具有极大的优势,但是标准的膀胱癌根治术后行原位回肠新膀胱术是一个操作较为复杂的手术,存在一定的并发症以及死亡率,而且,原位新膀胱为再造的膀胱,在储尿、排尿以及控尿方面仍存在一定的不足。     

腹腔镜下全膀胱切除并去带乙状结肠新膀胱术(附26例报告)

目的 介绍腹腔镜下全膀胱切除、去带乙状结肠新膀胱术的经验。方法 对2002年7月~2004年9月间26例膀胱癌患者的临床资料进行总结与分析。结果 26例患者的手术时间为240~390min,其中腹腔镜下全膀胱切除术120~270min。腹腔镜手术中及术后未见明显出血,出血量<200ml。开放性原位新膀胱术出血量400~800ml,输浓缩红细胞0~4个单位。术后4~8d恢复饮食,3~8周拔除输尿管支架管,4周拔除尿管。术后3个月患者白天可完全控制排尿,8例夜间偶有尿失禁。结论 腹腔镜下膀胱癌根治切除术创伤小、出血少、恢复快,是全膀胱切除手术中的一种很有前景的方法。全去带可控性乙状结肠新膀胱术具有手术操作简单、需用肠段短、贮尿囊在原位、尿液自尿道可控排出、术后并发症少等优点,具有较好的应用价值。     

Laparoscopic radical cystectomy with orthotopic ileal neobladder: report of 33 cases

Background The laparoscopic radical cystectomy (LRC) with orthotopic ileal neobladder is now applied to treat invasive bladder cancer, however, it has not been well codified and illustrated. We describe in this paper a technique step by step that we have developed in 33 patients and achieved excellent results.Methods The surgical procedure can be divided into eight steps: laparoscopic pelvic lymphadenectomy and mobilization of the distal ureters; exposing Denonvillier’s space and the posterior aspect of prostate; exposing retropubic space and anterior surface of the bladder; dividing the lateral pedicles of the bladder and the prostate; dividing the apex of the prostate; extracorporeal formation of the ileal pouch; extracorporeal implantation of the ureters; and laparoscopic urethra-neobladder anastomosis. This operation was performed in 33 patients, 29 males and 4 females, with muscle invasive bladder cancer between December 2002 and September 2004.Results The operating time was 5.5-8.5 hours with an average of 6.5 hours; the estimated blood loss was 200-1000 ml with an average of 460 ml. The surgical margins of the bladder specimen were negative in all patients. There was no evidence of local recurrence at follow-up of 1-21 months in all the patients. However lymph node metastases were found in one case at 9 months postoperatively. Most of patients achieved urine control 1 to 3 months after surgery. The daytime continence rate was 94% (31 cases) and nighttime continence rate was 88% (29 cases). Urodynamic evaluation was performed between 3 and 6 months postoperatively for all cases. The mean value of neobladder capacity was (296±37) ml. The mean value of maximum flow rate was (18.7±7.1) ml/s. The mean residual urine volume was (32±19) ml. In all cases, excretory urography at 1 to 2 months postoperatively demonstrated slightly dilated upper urinary tracts without ureteral obstruction, which resolved at follow up. Cystography showed neobladders being similar in shapes to normal. Two small ureteral nipples with intermittently efflux of urine were observed at cystoscopy in most patients. Postoperative complications occurred in 6 of 33 patients (18%), including pouch leakage in 2 cases, pelvic infection in 1, partial small bowel obstruction in 2 and neobladder-vaginal fistula in 1.Conclusions The LRC with orthotopic ileal neobladder is a feasible option for bladder cancer when radical cystectomy is indicated. The extracorporeal formation of the ileal pouch and ureteral implantation through a small lower midline incision can simplify the complexity of the procedures, shorten the duration of surgery and reduce the medical expenses.     

腹腔镜下膀胱根治性切除-原位回肠新膀胱术108例分析

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.     

膀胱全切原位W形回肠新膀胱术治疗膀胱癌临床分析

目的：探讨膀胱全切原位W形回肠新膀胱术治疗膀胱癌的临床疗效。方法：32例膀胱癌患者,其中男29
例,女3例,均行膀胱全切原位W形回肠新膀胱术。膀胱全切后,截取35~40 cm末端回肠,排列成W形制作原位新膀
胱。双侧输尿管与新膀胱乳头法吻合,尿道与新膀胱低位吻合。结果：所有患者手术均成功,术后患者可通过腹
压自主排尿,白天控尿率为87.5%,夜间控尿率为78.1%。术后6个月平均膀胱容量410.6 mL,残余尿量22.7 mL。
术后新膀胱漏尿3例,轻度肠梗阻2例,新膀胱尿道吻合口狭窄1例,新膀胱分泌物导致排尿困难3例,并发症经处
理后效果满意。9例术前有勃起功能男性患者,术后5例保留勃起功能;1例保留子宫和附件女性患者术后性功能正
常。平均随访15个月,1例患者因肺部感染、肿瘤远处转移死亡,其余患者均无瘤生存。结论：膀胱全切原位W形回
肠新膀胱术治疗膀胱癌术后患者可原位排尿,控尿良好,上尿路损害与电解质紊乱发生率低,可作为膀胱全切尿流
改道的首选。术后应注意并发症的处理和随访。     

女性膀胱癌腹腔镜根治性切除原位回肠新膀胱术术式改进

目的 探讨并改进腹腔镜女性膀胱癌根治性切除-原位回肠新膀胱术的手术方法,随访观察其治疗效果.方法 2003年2月至2008年9月,为19例女性膀胱癌患者施行了腹腔镜膀胱全切除-原位回肠新膀胱术,其中13例同时行子宫、卵巢及附件切除,6例行保留子宫、卵巢附件.主要手术步骤为:①行标准盆腔淋巴结清扫,②行膀胱全切除同时切除或不切除内生殖器,③在下腹正中线上作4～5 cm切口,取出标本,并构建"M"形去管回肠储尿囊,④输尿管末端形成半乳头,"插入式"种植于储尿囊;⑤储尿囊回纳腹腔,在腹腔镜下作储尿囊与尿道吻合.术后记录围手术期情况,并对患者进行定期随访,了解患者的生活质量、排尿情况,并检测患者的残余尿量、新膀胱压力等.结果 手术时间(340.5±43.1)min,术中出血(353.9±71.3)ml.术后随访2～69个月,半年内均能自主排尿,1例日间偶有尿失禁,2例夜间尿失禁,3例排尿困难.膀胱容量(333.6±45.4)ml,残余尿量0～210(41.2±18.1)ml.术后半年至1年,行静脉尿路造影,除1例单侧肾积液外,其余双肾显影良好,未见肾盂输尿管扩张.膀胱尿道造影,可见膀胱位于盆腔,其形状大小位置于正常膀胱相似,未见膀胱输尿管反流.术后输尿管新膀胱吻合口梗阻1例,新膀胱阴道瘘1例,肿瘤远处转移2例于随访期间死亡.结论 腹腔镜女性膀胱全切除-原位回肠新膀胱术,技术上可行,可根据患者情况采用保留或切除内生殖器的手术方法,术中出血较少,创伤较小,术后大部分患者能自主排尿,但尿失禁及排尿困难发生率略高于男性,术后中远期新膀胱功能及肿瘤根治效果还需进一步临床观察.     

Laparoscopic radical cystectomy with orthotopic ileal neobladder in the female: report of 14 cases

Background Bladder carcinoma is the most common malignant urological tumor in China. We present our preliminary experience and results of laparoscopic radical cystectomy （LRC） with orthotopic ileal neobladder in female patients with bladder carcinoma.
Methods From February 2003 to February 2008, 14 female patients with bladder carcinoma underwent LRC with orthotopic ileal neobladder. Nine of these patients underwent hysterectomy and ovariectomy, and the other 5 had preservation of the uterus and ovarian appendage. Standard bilateral pelvic lymphadenectomy was followed by radical cystectomy that was completed laparoscopically with hysterectomy and ovariectomy when needed. The tumor was removed by a 4-5 cm lower midline abdominal incision, followed by the construction of ileal neobladder and the extracorporeal anastomosis of ureter-neobladder. The neobladder was anastomosed to the urethral stump under a laparoscope.
Results The mean operative time and blood loss in the 14 patients were 350.2 minutes and 349.8 ml, respectively. Postoperative complications included uretero-pouch anastomotic stricture in 1 patient and pouch-vaginal fistula in 1 patient. Follow-up time of all patients ranged from 3 to 60 months, and 12 patients were followed up for more than 6 months and achieved micturition in half a year. One patient had occasional day-time urinary incontinence and 2 had night-time incontinence. Two patients who had undergone hystectomy and ovariectomy had voiding difficulties after one year, which was treated by intermittent self-catheterization. The mean volume of the neobladder and the residual urine were 333.6 ml and 31.2 ml, respectively. Surgical margins were tumor free for all patients. One patient had bone metastasis and died 11 months after the operation.
Conclusions LRC with orthotopic ileal neobladder in female patients is a technically feasible, safe and mini-invasive procedure with a low morbidity and acceptable neobladder function. Long-term follow-up is required to confirm the neobladder func     

护理干预膀胱全切全去带乙状结肠原位新膀胱的功能训练效果与评价

目的:探讨护理干预膀胱全切全去带乙状结肠原位新膀胱的功能训练效果。方法:将膀胱癌患者54例根据入院顺序分为试验组与对照组各27例,两组患者都采用膀胱全切全去带乙状结肠原位新膀胱术,试验组在手术治疗的基础上采用护理干预措施与积极的功能训练。结果:两组患者治疗后都痊愈出院,两组生理、独立性、环境以及个人信仰得分对比差异无统计学意义(P>0.05),心理、社会关系得分对比差异有统计学意义(P<0.05)。试验组的满意度为100.0%,对照组满意度为59.3%,对比差异有统计学意义(P<0.05)。结论:护理干预膀胱全切全去带乙状结肠原位新膀胱的功能训练能提高患者在心理与社会关系方面的生活质量,也能提高患者满意度,是较好的应用方法。