经尿道辅助单孔腹腔镜下根治性膀胱切除联合原位回肠新膀胱术的疗效及安全性

目的:探讨单孔腹腔镜下根治性膀胱切除术联合原位回肠新膀胱术的疗效及安全性。方法:选取2017年01月至2019年12月于本中心收治的17例膀胱癌患者，其中7例患者在经尿道途径的辅助下行单孔腹腔镜根治性膀胱切除术联合原位回肠新膀胱术；另外10例为对照组，行多孔腹腔镜下根治性膀胱切除术联合原位回肠新膀胱术，并对两组患者围手术期资料、手术并发症以及术后随访情况进行分析。结果:两组共17例膀胱癌患者均顺利完成手术，无中转开放手术。两组患者的年龄、体质量指数（body mass index,BMI)等差异均无统计学意义（P＞0.05）。单孔组与对照组平均手术时间分别为（341.4±52.1）min和（333.0±59.5）min，术中平均出血量分别为（206.4±104.6）mL和（190.5±82.3）mL，盆腔淋巴结清扫平均个数分别为17（7~22）个和18（12~23）个，术后平均住院天数分别为（25.1±5.4）d和（26.8±6.0）d，差异均无统计学意义（P＞0.05）。而单孔组在术后VAS疼痛评分和切口满意度评分上则优于对照组（P＜0.05）。其中单孔组患者术后随访12个月时患者的最大尿流量、最大膀胱容量、最大膀胱充盈量均明显比6个月时高，而随访12个月时患者的残余尿量较6个月时低，差异均具有统计学意义（P＜0.05）。结论:经尿道辅助单孔腹腔镜下根治性膀胱切除术联合原位回肠新膀胱术是安全可行的，且术后的新膀胱功能较为良好。

Efficacy and safety of transurethral-assisted laparoscopic single-site radical cystectomy combined with orthotopic ileal neobladder

Objective:To investigate the efficacy and safety of laparoscopic single-site radical cystectomy combined with orthotopic ileal neobladder.Methods:17 bladder cancer patients treated in our center from January 2017 toDecember 2019 were identified，of whom 7 cases underwent single port laparoscopic radical cystectomy plus orthotopic ileal neobladder surgery under the assistance of transurethral approach.The other 10 cases underwent porous laparoscopic radical cystectomy plus orthotopic ileal neobladder were defined in control group.The perioperative data，surgical complications，and postoperative follow-up were analyzed in both groups.Results:Patients in both groups completed the procedure uneventfully without conversion to open surgery.There were no significant differences in age or BMI between the two groups(P>0.05).The mean operative time for uniportal and control groups was (341.4±52.1)min and (333.0±59.5)min，the mean intraoperative blood loss of (206.4±104.6)mL and (190.5±82.3)mL，the mean number of pelvic lymph node dissections as 17(7~22) and 18(12~23)，and the mean postoperative hospital stay of (25.1±5.4)d and (26.8±6.0)d，respectively(P>0.05).However，the uniportal group had lower postoperative VAS pain scores and better incision satisfaction scores than those in the control group(P＜0.05).Among them，patients in the uniportal group had significantly higher maximum urine flow，maximum bladder capacity，and maximum bladder filling volume at 12-month postoperative follow-up than those at 6-month follow-up.While the residual urine volume at 12-month follow-up was lower than that at 6-month follow-up(all P＜0.05).Conclusion:Transurethral-assisted laparoendoscopic single-site radical cystectomy plus orthotopic ileal neobladder is safe and feasible，with relatively well postoperative neobladder function.