腹腔镜下根治性膀胱切除术-回肠膀胱术的技术与经验  

Technology and experience in laparoscopic radical cystectomy with ileal conduit

作　　者：艾星[1] 贾卓敏[1] 孙玉成[1] 郭岩杰[1] 高峰[1] 关亚伟[1] 臧桐[1] 孙凤岭[1] 郑清友[1] 张国晖[1] 

机构地区：[1]北京军区总医院泌尿外科,100760

出　　处：《中华泌尿外科杂志》2013年第8期603-607,共5页Chinese Journal of Urology

摘　　要：目的探讨腹腔镜下根治性膀胱切除术一回肠膀胱术的安全性和有效性。方法回顾性分析2008年5月至2011年6月54例腹腔镜下根治性膀胱切除术一回肠膀胱术患者资料。男49例，女5例。年龄44～71岁。T2期22例，T3期27例，T4期5例。单发肿瘤40例。分析54例患者的围手术期情况、术后并发症情况及肿瘤治疗效果，并进行随访。结果手术时间240～420min，中位时间340min。术中出血量100～400ml，平均220ml。术后肠道功能恢复时间3～6d。无围手术期死亡。切缘阳性3例，术后均接受局部放疗。平均清除淋巴结数为10枚／入，术后病理证实淋巴结阳性4例，淋巴结阳性患者术后给予辅助全身化疗。术后并发症发生率为20．4％（11／54）。54例患者术后随访1．5～4．5年，平均2．9年，总生存率为79．6％（43／54），其中4例死于肿瘤转移，7例死于心脑血管疾病。结论对于无原位回肠新膀胱手术机会的患者，腹腔镜F根治性膀胱切除术一回肠膀胱术是安全可行的微创术式之一，出血少，并发症少，术后初期肿瘤根治效果好，局部切缘阳性患者还可接受局部补救性放疗。Objective To investigate the safety and efficacy of laparoscopic radical cystectomy with ileal conduit. Methods Fifty-four cases of laparoscopic radical cystectomy with ileal conduit （22 cases in T2 stage, 27 cases in T3 stage, and 5 cases in T4a stage） were performed from May 2008 to June 2011. Forty- nine cases were males and 5 cases were females. The perioperative conditions, postoperative complications, and treatment methods were analyzed respectively and follow-up was carried out. Results The median operative time was 340 min （240-420 min） , the mean intraoperative blood loss was 220 ml （ 100-400 ml）, postoperative intestinal function recovery time was 3-6 days, and no perioperative death occurred. The total postoperative complication rate was 20.4% （11/54）. Three cases had positive margins in pathology, and lo- cal radiotherapy was perfomed postoperatively. The average number of lymph nodes in laparoscopic pelvic lymphadenectomy was 10 per person. Four cases were positive with lymph node, and all node-positive pa- tients received adjuvant systemic chemotherapy after postoperative recovery. The overall survival rate was 79.6% （43/54） with an average follow-up of 2.9 years （ 1.5-4.5 years）. Conclusions For patients without surgery opportunities of orthotopic ileal neobladder, laparoscopic radical cystectomy with ileal conduit could be a safe and feasible minimally invasive option, with less bleeding and fewer complications. The postoperative early tumor radical effect is good, and for the patients with local positive margins could receive local salvage pelvic radiotherapy.

关 键 词：腹腔镜 膀胱切除术 尿流改道术 回肠膀胱 膀胱肿瘤 

分 类 号：R737.14[医药卫生—肿瘤]