腹腔镜下腹膜外膀胱根治和原位新膀胱术的初步体会

目的 评估腹腔镜腹膜外全膀胱切除和原位新膀胱术的安全性及疗效。方法 回顾性分析安徽医科大学第二附属医院2021年3月至2022年2月行腹腔镜腹膜外全膀胱切除和原位新膀胱术的8例膀胱癌患者，收集患者的基本资料、手术相关数据及术后随访相关情况。结果 所有患者均顺利完成手术，年龄为[65(40～78)]岁，BMI为[23.85(19.59～29.07)]kg/m2，手术时间为[280.5(235.0～366.0)]min，术中出血量为[100(50～200)]ml，通气时间为[3(2～4)]d，术后住院时间为[11.5(10.0～20.0)]d，淋巴结清扫数目为[13.5(8.0～29.0)]枚。术后分别有一例患者出现切口愈合不良和漏尿。6例患者进行了术前新辅助治疗，其中2例患者术后病理为T0期。中位随访时间为11个月，其中1例出现骨转移，1例出现泌尿道感染，1例出现肾积水。结论 腹腔镜下腹膜外全膀胱切除及原位新膀胱术是安全可行的，因其极大程度地保留了腹膜的完整性及避免长时间经腹腔操作对肠道造成干扰，有利于减少肠道并发症，缩短住院时间，值得临床推广。

Preliminary experiences of laparoscopic extraperitoneal radical cystectomy with orthotopic ileal neobladder

ObjectiveTo evaluate the safety and efficacy of laparoscopic extraperitoneal radical cystectomy with orthotopic ileal neobladder. MethodsA retrospective analysis was performed on 8 patients with bladder cancer who underwent laparoscopic extraperitoneal radical cystectomy with orthotopic ileal neobladder in The Second Affiliated Hospital of Anhui Medical University from March 2021 to February 2022. The basic data, operative data and postoperative follow-up data of the patients were collected. ResultsAll patients had successful operations. The average age of all patients was [65(40-78)] years, BMI was [23.85(19.59-29.0)] kg/m², operation time was [280.5(235.0-366.0)] min, intraoperative blood loss was [100(50-200)] ml, ventilation time was [3(2-4)] d, postoperative hospital stay was[11.5(10.0-20.0)] d, and the number of lymph nodes dissected was [13.5(8.0-29.0)]. Among them, one patient had poor incision healing and another had urine leakage. Six patients received preoperative neoadjuvant therapy, and 2 of them had postoperative pathology at T₀ stage. The median follow-up time was 11 months, including 1 case with bone metastasis, 1 case with urinary tract infection, and 1 case with hydronephrosis. ConclusionsLaparoscopic extraperitoneal radical cystectomy with orthotopic ileal neobladder is safe and feasible. Because the peritoneal integrity is retained to a great extent and the interference of intestinal tract is avoided through peritoneal operation for a long time, it is beneficial to reduce intestinal complications and shorten the length of hospital stay, which is worthy of clinical promotion.