二次手术腹腔镜全膀胱切除的临床回顾性研究（附18例报告）

目的：探讨腹腔镜下根治性膀胱切除回肠膀胱术在膀胱部分切除术后复发的膀胱癌患者治疗中的应用价值。方法：回顾性研究18例二次予术腹腔镜全膀胱切除患者的临床资料，其中男14例，女4例。年龄44～76岁，平均年龄59．1岁，均曾经接受膀胱部分切除手术。在全身麻醉下行解剖性腹腔镜根治性膀胱切除，取下腹正中4～5cm切口取出标本，行回肠膀胱术13例，输尿管皮肤造瘘术5例。结果：手术时间240～360min，平均300min，其中腹腔镜下操作时间120～180min，平均142min。出血量100～1500ml，平均332ml。2例患者因术中出血较多给于输血，术后平均住院天数12．6天。术后随访6～24个月，1例患者术后1个月复查发现输尿管吻合口狭窄，1例患者术后行局部适形放疗，其余患者肾功能均正常，IVU检查未发现输尿管回肠吻合口狭窄或输尿管反流。结论：解剖性腹腔镜下膀胱根治性切除术治疗膀胱部分切除术后复发的膀胱癌患者临床效果满意，操作精确，创伤小，恢复快，安全性好，适于具有较高腹腔镜水平的单位开展。

Laparoscopic Radical Cystectomy for Treatment of Bladder Cancer After Partial Cystectomy (Report of 18 Cases)

Objective：To present some experience in laparoscopic radical cystectomy for treatment of bladder cancer after partial cystectomy. Method：Eighteen patients （14 male and 4 female） with invasive bladder carcinoma were treated by laparoscopic radical cystectomy from June 2008 to December 2010. All the patients had ever re- ceived partial cystectomy. The mean age was 59.1 years （range 44 to 76 years）. A 4-5 cm suprapubic incision was made to remove the bladder. Thirteen patients received Bricker operation and five patients received cutaneous ure- terostomy. Result：the surgery lasted 240 to 360 min （mean 300 rain）, with laparoscopic surgery having taken 120 to 180 rain （mean 142 rain）. The blood loss was 100 to 1 500 ml （mean 332ml）. Two patients reveived blood transfusions for massive bleeding during operation. No perioperative complications were encountered. Follow-up for 6 to 24 months revealed only one case of ureteral obstruction and no evidence of ureteral reflux or ureteral obstruc- tion in intravenous, another one received conformal radiotherapy to control the residual tumor cells. Conclusion： With the improvement of surgical technique, laparoscopic radical cystectomy has become a surgery of choice for treatment of tumor recurrence after partial cystectomy, because of its little trauma, short operating time and rapid recovery.