腹腔镜根治性全膀胱切除加回肠膀胱术治疗浸润性膀胱癌16例疗效分析

目的探讨腹腔镜下根治性全膀胱切除加回肠膀胱术的手术方法及临床疗效。方法收集2008年6月至2011年6月应用腹腔镜下根治性全膀胱切除加回肠膀胱术患者16例,对其资料进行回顾性分析和总结。结果所有手术均获得成功,无中转开放,手术时间260～430 min,平均320 min;术中出血420～1200 mL,平均490 mL;平均淋巴结清扫数16个,淋巴结阳性率14.9%,手术切缘均阴性。术后3～5 d肠道蠕动功能恢复,术后2周拔出单J管,无肠漏及尿漏并发症发生。随访1～32个月,1例死于原发病转移,其余患者一般情况尚可,无腹壁造口狭窄发生,肾功能正常,静脉尿路造影检查未见输尿管吻合口狭窄或反流。结论腹腔镜下根治性全膀胱切除具有创伤小、出血少、恢复快、盆腔淋巴结清扫彻底等优点,但手术难度较大,手术技术要求较高。回肠膀胱术操作简单易行,并发症少,疗效确切,可作为腹腔镜膀胱癌根治术后一种较为理想的是尿流改道方式。

Efficacy Analysis of Laparoscopic Radical Cyctectomy and Ileal Conduit Diversion for Carcinoma of Bladder in 16 Cases

Objective To present the surgical methods and clinical efficacy of laparoscopic radical cystectomy and ileal conduit diversion.Methods The clinical data of 16 cases of patients underwent laparoscopic radical cyctectomy and ileal conduit diversion were analyzed retrospectively and summarized between June 2008 and June 2011.Results All the operations were successfully completed without conversion to open surgery.The operation duration of surgery was 260 to 430 min with a mean of 320 min.The blood loss was 420 to 1200 mL with a mean of 490 mL.The average number of nodes of dissection was 16 with the positive nodes involvement of 14.9%.The surgical margin was negative in all cases.The bowel recovery time was 3-5 days.The ureteral stents were removed in 2 weeks.There was no complication of urinary leakage.After 1-32 months of follow-up,1 case died of metastasis of the primary disease;there was no case of stoma stenosis.Intravenous urography showed no evidence of ureteral reflux or ureteral obstruction.Conclusion Laparoscopic radical cystectomy has the advantage of minimal invasion and rapid recovery.The procedure is complex and requires advanced technique of operator.Ileal conduit is a simple procedure with less complications,which is an alternative type of urinary diversion after the procedure of laparoscopic radical cystectomy.