摘要
目的:总结腹腔镜下膀胱肿瘤根治术加回肠原位膀胱术的经验。方法:15例患者中男11例,女4例,年龄46～72岁,平均6l.8岁,采用5点穿刺法,腹腔镜由脐部下缘导管进入,手术者经左侧2个套管操作,助手经右侧2个套管操作。从右到左分别游离输尿管中下段并进行盆腔淋巴结清扫,输尿管暂不离断。男性患者先游离并离断输精管、精囊,前列腺后壁及前壁,紧贴前列腺尖部离断尿道,再行膀胱前列腺全切;女性患者在行膀胱全切除的同时作子宫及附件切除。在下腹正中线上作长4～5 cm切口,取出标本.回肠拉出切口外,取回盲部交界15 cm近侧隔离50 cm回肠段纵行剖开该肠后M形折叠形成贮尿囊,将输尿管末段1 cm插入贮尿囊后顶部作吻合。贮尿囊最低位开口与尿道断端行6针吻合。结果:手术耗时5～8 h,平均6.3 h,出血量400～800mL,平均447mL,术后所有患者3～4 d肠道功能开始恢复,1个月行B超、IVU及新膀胱造影检查示:双肾显影良好,无输尿管返流及梗阻,新膀胱充盈良好,容量约300mL,15例患者均于术后4～6周内均恢复控尿能力,无排尿困难及尿失禁症状。结论:腹腔镜下行膀胱全切除视野清楚,有助于精确地处理盆底深部的重要结构,术中出血少,尿道括约肌损伤概率较小,有助于减少术后肠粘连,保护身体的免疫机制,减少术后感染,小切口取出标本,体外构建贮尿囊,吻合输尿管,可缩减手术时间,减少腹腔内污染。
Objective： To summarize the experience and benefits of laparoscopic radical cystectomy and orthotopic ileal neobladder for bladder cancer. Methods： Fifteen patients （11 males and 4 females） with bladder carcinoma underwent laparoscopic radical total cystectomy with orthotopic ileal neobladder formation. Their mean age was 61.8 years （ range, 46 to 72 years ）, Using 5 trocars, the surgeon conducted the procedure through 2 ports on the left side, and the assistants participated on the right side while holding the laparoscope. The lower segments of the ureters were dissociated and pelvic lymphadenectomy was performed from the right to the left. Radical cystoprostatectomy was performed for the male patients. The whole bladder, uterus and appendage were removed for the female patients. A 4 to 5 cm incision （ median value ） in the lower abdomen was made to remove the surgical specimens and construct the ileal pouch. A 50 cm ileal loop was taken from the abdominal cavity, isolated, detubularized and reconfigured into an ＂M ＂shaped pouch with running sutures. The anti-refluxing ureter implantation was performed by inserting 1 cm of ureter into the pouch and suturing them together. Results： The mean surgical duration was 6.3 h （ 5-8 h ）, and the blood loss was 400 - 800 mL with a mean of 447 mL. The bowel recovery time of all patients was 3-4 days. The capacity of the neobladders was about 300 ml. Ureter reflux was not found using IVU or cystograpby a month after surgery. All patients had restored urination function 4-6 weeks after surgery. Conclusion： Laparoscopic radical cystectomy has the advantage of being minimally invasive with a rapid recovery. Laparoscopic neobladder-ureter anastomosis reduces bleeding, sphincter injury, intestinal adhesion, abdominal cavity pollution and nerve bundle injury. Laparoscopic radical cystectomy and neobladder-ureter anastomosis may become an alternative surgical method for patients with localized bladder cancer that has invaded muscle.
出处
《中国肿瘤临床》
CAS
CSCD
北大核心
2011年第6期335-338,共4页
Chinese Journal of Clinical Oncology
关键词
腹腔镜技术
膀胱肿瘤
全膀胱切除术
回肠代膀胱
Laparoscopic technique
Bladder neoplasm
Radical cystectomy
Ileal neobladder
