体外协助尿流改道的腹腔镜全膀胱根治性切除术  

Laparoscopic Radical Resection of Bladder with the Aid of Urinary Diversion in Vitro

作　　者：程晓冬[1] 丛军[1] 徐新宇[1] 于得水[1] 吴岩[1] 董坚[1] 

机构地区：[1]南京医科大学附属无锡第二医院泌尿外科,无锡214002

出　　处：《中国微创外科杂志》2013年第11期1012-1014,共3页Chinese Journal of Minimally Invasive Surgery

摘　　要：目的 探讨体外协助尿流改道的腹腔镜全膀胱根治性切除术的疗效.方法 2006年6月～2012年6月施行体外协助尿流改道的腹腔镜全膀胱根治性切除术28例,全膀胱切除和盆腔淋巴结清扫均在腹腔镜下完成,标本自下腹部小切口取出,体外协助尿流改道采用回肠膀胱术（Bricker手术）和原位回肠新膀胱2种术式,其中Bricker手术22例、原位回肠新膀胱术6例.结果 均一次手术成功,腹腔镜盆腔淋巴结清除及全膀胱切除手术时间150～240 min,平均180 min;体外协助尿流改道时间90～270 min,平均150 min;术中出血200 ～900 ml,平均350 ml;肠功能恢复时间3～4d.6例原位回肠新膀胱2～4周拔除导尿管,能正常排尿,无尿潴留和肾功能损害发生.26例随访6～36个月,平均15个月,1例术后23个月死于复发及远处广泛转移,2例死于其他内科疾病,其余患者一般情况良好,未见肿瘤复发及转移.结论 体外协助尿流改道的腹腔镜全膀胱根治性切除术疗效满意.Objective To explore the efficacy of laparoscopic radical resection of bladder with the aid of urinary diversion in vitro.Methods A total of 28 patients with muscle-invasive bladder cancer underwent laparoscopic radical resection of bladder combined with urinary diversion in vitro from June 2006 to June 2012.Radical resection of bladder and bilateral pelvic lymphadectomy were performed under laparoscope.Surgical specimens were taken out from small incision of lower abdomen.For urinary diversion in vitro,22 patients were performed by ileal conduit diversion and 6 patients orthotopic ileal neobladder.Results All operations were performed successfully.The time of laparoscopic pelvic lymphadenectomy and resection of urinary bladder was 150-240 min （mean,180 min）,and the time of urinary diversion in vitro was 90-270 min（mean,150 min）.Intraoperative blood loss was 200-900 ml （mean,350 ml）.The intestinal function recovery time was 3-4 d.All 6 patients of orthotopic ileal neobladder could urinate normally following catheter removal 2-4 weeks postoperatively without uroschesis or renal function damage.All patients received a follow-up of 6 to 36 months （mean,15 months）.During the follow-up,23 patients were in good condition and no tumor recurrence or metastasis was found.One patient died of tumor recurrence and metastasis 23 months after operation and two patients died of other internal medicine diseases.Conclusion Laparoscopic radical resection of bladder with the aid of urinary diversion in vitro is characterized by satisfactory curative effect.

关 键 词：膀胱癌 腹腔镜 体外 尿流改道 

分 类 号：R737.14[医药卫生—肿瘤]