腹腔镜手术治疗脐尿管癌4例及文献复习

目的:探讨腹腔镜手术治疗脐尿管癌的可行性和临床疗效。方法:2007年1月-2014年6月，对4例平均年龄54岁，肿瘤最大径平均3.6cm(2.4～5.2cm)的脐尿管肿瘤患者行腹腔镜手术治疗。手术切除范围包括膀胱顶部、肿瘤相连的腹膜与Retzius间隙内的结缔组织、脐、脐尿管、肿瘤周围2cm的膀胱壁及双侧盆腔淋巴结清扫。记录手术时间、出血量及术后住院时间，术后随访患者生存时间及有无肿瘤复发。检索PubMed及国内CMB等数据库中相关文献，讨论脐尿管肿瘤发病特点、影像学特征及临床诊治。结果:4例手术均成功，无中转开放手术，平均手术时间125min，术中估计平均出血量60ml，术后平均住院时间5天，留置引流管时间平均3天。术中、术后无严重并发症发生。术后病理诊断黏液腺癌3例，乳头状腺癌1例，所有病例切缘及淋巴结均为阴性。术后平均随访14个月，均存活，未发现肿瘤局部复发或远处转移。结论:脐尿管癌预后与肿瘤临床分期关系密切，CT、MRI及膀胱镜检查是主要诊断手段，扩大性膀胱部分切除术是治疗局限性脐尿管癌的主要治疗方法。相对于开放手术，腹腔镜手术治疗脐尿管肿瘤具有创伤小、手术视野清晰、术后恢复快等优点，是一种值得推广的微创方法。

Laparoscopy for treatment of 4 urachal carcinoma and review of the literature

Objective:To discuss the feasibility and clinical efficacy of laparoscopic treatment of urachal carcinoma.Methods:From January 2007 to June 2014，4 patients with urachal carcinoma were managed by the laparoscopic procedure.Their median age at diagnosis was 54 years.The mean size of tumors was 3.6cm in diameter.The boundaries of resection were in cluding resection of the tumor with normal margins，the peritoneum lateral to the two medial unbilical ligaments，the posterior sheath of the rectus muscle and the muscle fibers of the rectus muscle below it，and bilateral pelvic lymphanodes.The operating time，estimated blood loss and mean post-operative hospital stay were recorded.The follow-up was done to evaluate the survival and recrudescence.PubMed and domestic CBM database search in the related literature，dicuss urachal carcinoma incidence characteristics，imaging features and clinical diagnosis and treatment.Results:All 4 procedures were completed successfully with no conversion to open surgery.The median operating time was 125 minutes with a median estimated blood loss of 60ml.The median post-operative hospital stay was 5 days.The median duration of drainage catheter was 3 days.No serious complication was occurred during surgery and post-operative.The postoperative pathological diagnosis was urachal adenocarcinoma in 3 cases and papillary in 1 case.The evaluations of bladder margins for cancer and lymph nodes were negative in all cases.At a median follow-up of 14 months，there was no evidence of recurrent disease by radiologic or cystoscopic evaluation.Conclusion:Tumor stage is the most important predictor of prognosis，CT and MRI scan is critical for diagnosis of urachal carcinoma.Extended partial cystectomy is the main surgery of patients with urachal carcinoma.Laparoscopic management of urachal carcinoma has the advantages of little trauma，clear surgery vision and faster postoperative recovery.It is a minimally invasive mehod and is worthy to be widely applied.