腹腔镜全膀胱切除-原位回肠膀胱术（5例报告）

目的探讨腹腔镜全膀胱切除-新膀胱术的手术方法和临床效果。方法膀胱移行细胞癌患者5例，27-64岁（平均49．8岁）。均经腹腔镜下行全膀胱切除-原位回肠膀胱术，经腹壁切口取出标本，然后将回肠牵出切口截取40cm长回肠段，剖开建成“M”型贮尿囊，并与双侧输尿管吻合再置入腹腔与腹腔镜下行贮尿囊尿道吻合建成原位回肠膀胱。行回肠新膀胱术。结果5例手术均获成功，手术时间5-7h，平均6．0h。出血量200～510ml，平均340ml，无输血。术后2～3天恢复肠道功能。术后三个月随访时患者排尿良好，新膀胱无明显残余尿，容量200-350ml。结论腹腔镜全膀胱切除-原位回肠膀胱术创伤小、出血少、恢复快，很有前景，但还需要长时间随机对照和随访研究。

Laparoscopic radical cystectomy with orthotopic neobladder(report of 5 cases)

Objective To study the surgical procedure and results of laparoscopic radical cystectomy (LRC) with orthotopic neobladder. Methods 5 patients with bladder transitional cell carcinoma underwent LRC, the age ranged from 27 to 64 years old (mean 49.8 years old). The ileal pouch (so called neobladder) were made from out of the median incision in the lower abdomen. Results All the operation were finished successfully, the duration of surgery ranged from 5 to 7 hours, mean 6.1 hours. The blood loss was 200 to 510 ml, no one needed blood transfusion. The intestine function recovered about 2～3 days after operation. After 3 months follow-up after surgery, all patients avoided well, no residual urine in the neobladders by ultrasonography, the neobladder volume was 200～350 ml. Conclusion With minimal invasion, less blood loss and rapid recovery , LRC with othotopic ileal neobladder is a promising way for the patients who have the indication,but need a long-term random control and catamnestic research.