腹腔镜下根治性全膀胱切除术加尿液改道治疗浸润性膀胱癌15例

【摘要】〓目的〓总结腹腔镜下全膀胱切除的经验。方法〓2010年8月至2015年1月治疗浸润性膀胱癌15例,男性13例,女性2例,年龄61~79岁,平均68岁。术前临床诊断:T2N0M0~ T3N0M0。腹腔镜下行盆腔淋巴结清扫,全膀胱切除,前列腺切除或子宫全切除、阴道壁部分切除。尿流改道方式:原位回肠新膀胱术4例;回肠通道术9例;输尿管皮肤造口术2例。结果〓15例手术成功,手术时间220~550 min(平均400 min)。出血量100~800 mL(平均240 mL);术中、术后输浓缩红细胞0~400 mL(平均200 mL)。术后3~8 d恢复饮食,3周拔除输尿管支架管,原位膀胱术者4周拔除尿管。随访1~40个月,无严重并发症发生。结论〓腹腔镜下根治性全膀胱切除术创伤小、出血少、术中操作精细、盆腔淋巴结清扫彻底、术后恢复快,可作为全膀胱切除手术的首选方法。

Laparoscopic radical cystectomy and urinary diversion for the treatment of invasive bladder cancer (report of 15 cases)

【Abstract】〓Objective〓To summarize the experience of laparoscopic radical cystectomy. Methods〓Fifteen patients were reported who underwent surgery from August 2010 to January 2015,13 males and 2 females, aged 61-79 years old (average 68 years old) with organ confined, muscle included invasive carcinoma of the bladder. Preoperative clinical diagnosis ranged T2-3N0M0. The surgical procedure was as follows:laparoscopic radical cystectomy and extended pelvic lymph node dissection with removal of prostate or total excision of the uterus and vaginal wall resection. Urinary diversion method included 4 cases of orthotropic ileal neobladder, 9 cases of ileum channel operation, and 2 cases of ureter skin ostomy. Results〓Fifteen operations were successfully performed. The operative time was 220-550 min (average 400 min). The blood loss was 100-800 ml (average 240 ml). Blood transfusion was 0-400 ml (average 200 ml) during and after operation. Oral intake was started on hospital day 3-8. Ureteral stents were removed 3 weeks after operation and the urine tubes in the patients with ileal neobladder were removed in the fourth week. There were no severe complications during 1-40 month of follow-up. Conclusion〓Laparoscopic radical cystectomy is the good choice for radical cystectomy due to small trauma, less bleeding and speedy postoperative recovery.