LRC术中膀胱侧、后韧带及前列腺侧血管蒂处理方法改进  

Improvement in surgical dissection of the lateral and posterior vesical ligaments,as well as the lateral prostatic pedicle,during laparoscopic radical cystectomy

作　　者：赵润恒 李炯明[1] 张小德[2] 刘建和[1] 陈戬[1] 闫永吉[1] 姜永明[1] 张劲松[1] 王光[1] 崔茂荣[2] 张海燕[1] 

机构地区：[1]昆明医科大学第二附属医院泌尿外科,650101 [2]云南省曲靖市第一人民医院泌尿外科

出　　处：《现代泌尿生殖肿瘤杂志》2014年第3期143-145,共3页Journal of Contemporary Urologic and Reproductive Oncology

摘　　要：目的 探讨腹腔镜根治性膀胱癌切除手术中膀胱侧韧带、后韧带及前列腺侧血管蒂的处理方法。方法 根治术前先结扎髂内动脉分支以减少膀胱及前列腺动脉血供及静脉回流,对膀胱侧、后韧带及前列腺侧血管蒂的内、外侧缘充分游离后再进行切断处理。结果 按设计的方法在56例手术中完成了对膀胱侧、后韧带及前列腺侧血管蒂的处理,根治手术时间平均170min,出血量平均160ml。其中每侧手术时间平均为4min,出血量10~20ml,无直肠损伤发生。结论 采用本手术改进方法处理膀胱侧、后韧带及前列腺侧血管蒂,能有效缩短手术时间、减少出血及避免直肠损伤。Objective We describe an improvement in the surgical technique of mobilization and excision of the lateral and posterior vesical ligaments as well as the lateral prostatic pedicle during laparoscopic radical cystectomy. Methods Bilateral internal iliac artery ligation was firstly performed to reduce arterial inflowing to and venous blood return from the bladder and the prostate, followed by adequate mobilization of the medial and lateral borders of the posterior and lateral vesical ligaments and lateral prostatic pedicle, prior to their ligation and division. Results 56 cases underwent the aforementioned technique as described above. The laparoscopic operative time and the blood loss were 170 min and 160 ml respectively. The operating time for this stage of the operation for each side ranged between 3-7 min with an average of 4 min. Neither significant blood loss nor rectal injury was encountered in all the cases. Conclusions The new technique can improve handling of the posterior and lateral vesical ligaments as well as the lateral prostatic pedicle, which shows initial promise in the reduction of operative time, blood loss and avoidance of rectal injury.

关 键 词：根治性膀胱切除 腹腔镜 膀胱侧韧带 膀胱后韧带 前列腺侧血管蒂 

分 类 号：R737.14[医药卫生—肿瘤]