腹腔镜下膀胱全切Bricker回肠膀胱术与Studer原位膀胱术的比较研究

目的比较腹腔镜下膀胱全切Bricker回肠膀胱术和Studer原位膀胱术的手术、肿瘤学等指标，探讨腹腔镜膀胱全切尿流改道术的最佳术式。方法腹腔镜下膀胱全切Bricker回肠膀胱术15例和Studer原位膀胱术12例，其中男性分别为14和10例，女性分别为1和2例，平均年龄分别为（64．47±11．31）和（69．33±10．46）岁，肿瘤平均直径分别为（4．79±1．82）和（2．63±1．00）cm。结果全部手术均顺利完成，无一例中转开腹。Bricker回肠膀胱术和Studer原位膀胱术的手术时间分别为（422．00±131．97）和（370．00±104．19）min，术中出血量分别为（623．33±377．43）和（575.00 ±491．52）ml，术中输血量分别为（314．26±357．03）和（320．00±413．12）ml，患者住院天数分别为（19．40±4．48）和（23．92±11．25）d。随访3～48个月，所有患者均无复发。Bricker回肠膀胱术组1例患者术后13个月因心脑血管意外死亡。Studer原位膀胱术组1例患者术后出现输尿管套叠，输尿管镜下将其顺利还纳。Studer原位膀胱术后3个月时，患者白天控尿率和夜间控尿率分别为83．33％和75．00％；术后6个月时，患者白天控尿率和夜间控尿率均为100％。术后病理类型，Bricker回肠膀胱术组低分级乳头状尿路上皮癌10例，高分级乳头状尿路上皮癌4例和腺癌1例；Studer原位膀胱术组低分级乳头状尿路上皮癌2例，高分级乳头状尿路上皮癌6例和腺癌4例。术后病理分期，Bricker回肠膀胱术组pT2aN0M05例，pT2bN0M09例，pT2bN00例，pT3aN0M01例；Studer原位膀胱术组pT2aN0M02例，pT2bN0M07例，pT2bN2M01例，pT3aN0M02例。结论腹腔镜膀胱全切Studer原位膀胱术与Bricker回肠膀胱术具有相似的手术和肿瘤学等方面的结果，但Studer原位膀胱术患者术后生活质量较高，是一种效果良好的膀胱全切尿流改道术式。

The comparision research on peri-operative and oncologic results of Bricker conduit and Studer orthotopic ileal neobladder after laparoscopic radical cystectomy

Objective To explore the optimal urinary diversion after laparoscopic radical cystectomy, by comparing the peri-operative and oncologic results of Bricker conduit with those of Studer orthotopic ileal neobladder. Methods From September 2004 to September 2008,15 patients received Bricker diversion and 12 patients received Studer orthotopic ileal neobladder after laparoscopic radical eystectomy. All operations were performed successfully under laparoscopy. Results In Bricker diversion group and Studer orthotopic ileal neobladder group, the results were as follow.. 14 and 10 male patients,mean age （64.47± 11.31） and （69.33± 10.46） years old,the average tumor diameter （4.79±1.82） and （2. 63±1.00） cm,operation time （422.00±31.97） and （370.00± 104.19） minutes,blood loss （623.33±377.43） and （575.00±491.52） ml,blood transfusion during operation （314.26±357.03） and （320.00 ± 413. 12） ml, hospitalization time （19.40 ± 4.48） and （23.92±11.25） days respectively. No recurrence was found during follow-up （3-48 months）. One patient in Bricker diversion group died 13 months after operation due to cerebrovascular accident. One patient in Studer orthotopic ileal neobladder was found right ureteral indigitation, which was solved successfully by ureteroscopy. The daytime and nighttime continent rate was 83. 33% and75.00%,100% and 100% respectively,3 months and 6 months after the operation. The postoperative pathologic results were as follow：low grade urothelial carcinoma in 10 and 2 patients,high-grade urothelial carcinoma in 4 and 6 patients,adenocarcinoma in 1 and 4 patiens,respectively. The pathologic tumor stage were as follow： pT2a N0M0 in 5 and 2 patients, pT2b N0M0 in 9 and 7 patients, pT2abN2M0 in 0 and 1 patient,pT3aN0M0 in 1 and 2 patients,respectively. Conclusions The periop- erative and oncologic results of Studer orthotopic ileal neobladder after laparoscopic cystectomy are the same as those of Bricker conduit,however,the life quality of Studer orthotopic ileal neobladder is much more satisfactory. So the Studer orthotopie ileal neobladder is ideal urinary diversion method.