腹腔镜下全膀胱切除原位回肠新膀胱术(附16例报告)  

Laparoscopic radical cystectomy with ileal neobladder in 16 case of bladder cancer

作　　者：陈景宇[1] 李富林[1] 黄栋强[1] 

机构地区：[1]广东省惠州市第一人民医院泌尿外科,516001

出　　处：《现代泌尿生殖肿瘤杂志》2011年第5期261-263,共3页Journal of Contemporary Urologic and Reproductive Oncology

摘　　要：目的探讨在基层医院采用腹腔镜下全膀胱切除原位回肠新膀胱术的临床应用。方法对15例浸润性膀胱尿路上皮细胞癌Ⅱ～Ⅲ级、1例鳞状细胞癌患者行腹腔镜下全膀胱切除加原位回肠代膀胱术,观察手术时间、术中出血量、术后肠道功能恢复情况及术后并发症等手术效果。结果 16例患者膀胱根治均切除成功,手术时间240～320min。腹腔镜下失血量为100～500ml,平均为230ml。2例输浓缩红细胞2个单位。术后3d恢复肠蠕动并拔除耻骨后引流管,4d后开始进食。2周后拔除输尿管支架管。随访4～26个月,1例有排尿困难,5例术后早期出现轻微尿失禁,所有病例术后3个月均可完全控制排尿,5例男性患者有勃起功能障碍。16例均无复发。结论该术式具有微创、出血少、恢复快等特点,将成为治疗浸润性膀胱癌的安全、有效的方法之一,有可能在具有一定腹腔镜手术操作基础的基层医院逐步开展。Objective To explore the potential clinical application of laparoscopic radical cystectomy with orthotopic ileal neobladder in basic hospitals.Methods Fifteen cases of patients with bladder transitional cell carcinoma （gradeⅡ-Ⅲ） and 1 case of bladder squamous cell carcinoma underwent laparoscopic radical cystectomy with orthotopic ileal neobladder.The operation time,the blood loss,the postoperative intestine function recovery time and the complication were examined.Results All operations were successfully performed,the operation time between 240-320 min.The blood loss was 100-500 ml （mean 230 ml）.Two cases received blood transfusion.The intestine function recovered and the retropubic drain was removed about 3 days after operation.Oral food intake was allowed 4 days after operation.All ureteral stents were removed 2 weeks after surgery.The patients were followed-up for 4-26 months.Five cases of patients presented with slight urinary incontinence during early postoperative period.All patients were able to control urination three months after operation.Five male cases developed erectile dysfunction.No patients relapsed during the follow-up.Conclusions We believe that laparoscopic radical cystectomy with orthotopic ileal neobladder represents a safe and efficient approach for the treatment of muscle-invasive bladder cancer,with advantages of minimal invasion,less blood loss and rapid postoperative recovery.It is worth to be widespread in basic hospitals.

关 键 词：膀胱肿瘤 腹腔镜 全膀胱切除术 原位回肠代膀胱 

分 类 号：R737.14[医药卫生—肿瘤]