腹腔镜下全膀胱切除术疗效及早期并发症的临床分析  

Early stage postoperative complications of laparoscopic radical cystectomy

作　　者：许传亮[1] 曾蜀雄[1] 张振声[1] 于晓雯[2] 宋瑞祥[1] 韦荣超[1] 鲁欣[1] 李惠珍[1] 周铁[1] 杨波[1] 高旭[1] 侯建国[1] 王林辉[1] 孙颖浩[1] 

机构地区：[1]第二军医大学附属长海医院泌尿外科,上海200433 [2]第二军医大学附属长海医院老年科,上海200433

出　　处：《中华泌尿外科杂志》2014年第7期539-542,共4页Chinese Journal of Urology

基　　金：上海市卫生系统优秀人才培养计划（XBR2013076）

摘　　要：目的：总结腹腔镜下全膀胱切除术的疗效及早期并发症发生情况。方法回顾性分析2011年10月至2013年10月收治的63例行腹腔镜下全膀胱切除术患者的临床资料，男58例，女5例。年龄33～84岁，平均（67．7±11．1）岁。伴有高血压10例，糖尿病6例，冠心病2例，肝硬化失代偿1例。既往有腹部手术史10例。体质指数为18．8～28．7 kg/m2，平均（23．3±2．1）kg/m2。术前血红蛋白平均为（130．7±20．3）g/L，白蛋白平均为（38．9±4．1）g/L。30例行诊断性经尿道膀胱肿瘤电切术（ TURBT）证实为肌层浸润性尿路上皮癌，19例为TURBT难以切除的大面积膀胱肿瘤，14例为复发性膀胱癌。63例均行腹腔镜下全膀胱切除术＋尿流改道术，其中46例行回肠膀胱术、9例行输尿管皮肤造口术、8例行回肠原位膀胱术。结果本组63例，其中1例中转开放手术，手术时间为260～480 min，平均390 min；术中出血量100～1500 ml，平均400 ml。术后血红蛋白平均为（108．5±14．7）g/L，白蛋白平均为（29．5±3．7）g/L，与术前比较差异均有统计学意义（P＜0．01）。术后平均住院时间15 d。术后平均4 d恢复进食，9 d拔除盆腔引流管，原位膀胱术后14 d拔除导尿管。本组63例均于术后2个月拔除输尿管支架管。术后21例（33．3％）出现并发症，其中回肠膀胱术15例（15/46，32．6％），包括肠梗阻5例，淋巴漏5例，肺部感染、肾盂肾炎、气胸、精神异常、肠瘘各1例，其中肠梗阻和肠瘘各1例行二次手术治疗，余均对症治疗后好转；输尿管皮肤造口术2例（2/9，22．2％），不全肠梗阻和淋巴漏各1例，对症治疗后好转；回肠原位膀胱术4例（4/8，50．0％），包括肠梗阻2例，淋巴漏和心律失常各1例，肠梗阻1例行二次手术治疗。结论腹腔镜下全膀胱切除术安全、可靠，术中出血少，术后并发症发生率较低，但术后患Objective To investigate feasibility and early stage postoperative complications of lapa-roscopic radical cystectomy （ LRC） . Methods We retrospectively analyzed the data of 63 consecutive pa-tents （58 males and 5 females） who underwent LRC from Oct .2011 to Oct.2013 in our institute.Of these patients, 46 patients underwent ileal conduit , 9 patients underwent ureterocutaneostomy , and 8 patients un-derwent orthotopic ileal neobladder urinary diversion .The average age and body mass index of patients were 67.7±11.1 （33-84） years and 23.3±2.1 （18.8-28.7） kg/m2, respectively.The mean hemoglobin and al-bumin of patients were （130.7±20.3） g/L and （38.9±4.1） g/L, respectively.Comorbidities of hyperten-sion, diabetes, coronary heart disease and decompensated liver cirrhosis were found in 10, 6, 2 and 1 pa-tient, respectively.10 of 61 patients had a history of abdominal surgery .The indications for cystectomy were classified as muscle invasive bladder cancer for 30 patients, unresectable superficial bladder cancer for 19 patients and recurrent bladder cancer for 14 patients.Postoperative data and early stage postoperative compli-cations within 3 months after surgery were collected . Results The median operative time for LRC and uri-nary diversion was 390 （260-480） min, with a median estimated blood loss of 400 （100-1 500） ml.This was one patient converted to open surgery .The mean postoperative hemoglobin and albumin of patients was 108.5±14.7 g/L and 29.5±3.7 g/L, respectively, both of which significantly reduced compared with pre-operative data （P〈0.01）.The median duration of hospital stay was 15 days.The median time for liquid in-take, abdominal drainage removal and ureteral stent removal was 4 days, 9 days and 2 months after surgery , respectively.Catheter was removed 2 weeks after laparoscopic orthotopic cystectomy .21 （33.3%） of 63 pa-tients suffered from perioperative complications .15 of 46 patients （32.6%） in ileal conduit group had com-plications including il

关 键 词：腹腔镜 膀胱切除术 膀胱癌 并发症 

分 类 号：R699.5[医药卫生—泌尿科学]