摘要
目的：介绍腹腔镜下全膀胱切除原位回肠新膀胱重建术的经验。方法：采用腹腔镜下全膀胱切除原位回肠新膀胱重建术治疗浸润性膀胱癌患者5例。方法是经腹壁小切口取出切除物，行回肠去管成形新膀胱，然后在腹腔镜下将新膀胱与尿道连续吻合。结果：5例患者手术成功，手术时间4．5～7．2h。腹腔镜手术中以超声刀及双极电凝行膀胱侧韧带、前列腺血管蒂及前列腺尖部切断止血，未使用钛夹、术中出血量180～550ml，平均输血400ml。术后4～5天恢复饮食，3周拔除输尿管支架管，4周拔除尿管。患者白天可完全控制排尿，2例夜间偶有尿失禁。1例术后尿漏，经引流治愈。结论：腹腔镜下全膀胱切除术具有创伤小、出血少、恢复快等优点；而回肠新膀胱和尿道连续吻合具有操作方便、省时、缝合紧密、可防止尿漏等优点。
Objective：To present the initial experience and results of the laparoscopic radical cystectomy（LRC） with orthotopic neobladder. Methods：Three male and two female patients with invasive bladder carcinoma had been operated on with LRC with orthotopic ileal neobladder. The mean age was 67.25 years（range, 58 to 73 years）, The LRC with orthotopic neobladder consisted of 3 major steps namely laparoscopic cystectomy, extracorporeal formation of ileal neobladder and laparoscopic urethra-ileal neobladder anastomosis. Results： The operative time ranged from 4.5 to 7.2 hours （median 6.3 hours）. The blood loss was 180 to 550 ml. Mean transfusion was 400 ml. Oral feeding was resumed within the 4th to 5th postoperative day. The stents were usually removed on the 21 postoperative days ,and the urethral catheter was removed on the 28 postoperative days . After one to four months followup all patients were alive and asymptomatic with upper tracts and had no evidence of local recurrence or metastasis. Four patients with orthotopic ileal neobladder had complete daytime continence, Conclusions： Laparoscopic radical cystectomy with orthotopic neobladder is feasible ,although difficult and technically demanding. With growing experience ,laparoscopic radical cystectomy and continent urinary diversion can be an alternative to the open technique. Running urethroileal anastomosis is important.
出处
《临床泌尿外科杂志》
2006年第9期651-653,共3页
Journal of Clinical Urology
