保留前列腺段尿道的腹腔镜膀胱癌根治-原位回肠膀胱术的临床探讨  

Clinical study of laparoscopic radical resection of bladder carcinoma and ileal neobladder in situ with reservation of prostatic urethra

作　　者：王定勇[1] 邓金华[2] 辛宇鹏[2] 郭霖森 王魏龙 田峰[1] 赵修民[1] 李华[1] 

机构地区：[1]绵阳市人民医院,四川绵阳621000 [2]绵阳市中心医院

出　　处：《腹腔镜外科杂志》2015年第11期808-811,共4页Journal of Laparoscopic Surgery

摘　　要：目的：探讨完整保留前列腺段尿道、腹腔镜膀胱癌根治-原位回肠膀胱术的临床疗效。方法：2010年3月至2015年3月为12例患者行经腹腹腔镜盆腔淋巴结清扫,保留前列腺段尿道膀胱癌根治切除,小切口体外重建回肠新膀胱,腹腔镜下行新膀胱尿道吻合重建。结果：手术时间220-330 min,平均（270±60）min,术中失血量100-300 ml,平均（180±120）ml。手术切缘均为阴性。随访3-48个月,无一例复发及尿失禁,代膀胱充盈良好,容量200-450 ml,平均（320±130）ml,平均最大尿流率（7±5）ml/s。结论：保留前列腺的腹腔镜膀胱癌根治-原位回肠膀胱术创伤小、出血少、并发症少且完整保留了男性性功能,疗效满意,严格掌握手术适应证可取得较好的临床应用价值,但对肿瘤控制的远期效果尚待进一步比较观察。Objective： To investigate the clinical effect of laparoscopic radical resection of bladder carcinoma and ileal neobladder in situ with reservation of prostatic urethra. Methods： From Mar. 2010 to Mar. 2015,a total of 12 males underwent transperitoneal laparoscopic pelvic lymph node dissection,radical resection of bladder carcinoma with reserving the prostatic urethra,reconstruction of ileal neobladder in vitro through small incision,laparoscopic connection of neobladder to the urethra. Results： The operation time ranged from 220 to 330 min,with an average of（ 270 ± 60） min,the blood loss was 100 to 300 ml,and the average was（ 180 ± 120） ml. Surgical margins were all negative. With follow- up of 3 to 48 months,there was no recurrence,no urinary incontinence,and the neobladder well filled with capacity of 200-450 ml and（ 320 ± 130） ml on average. The average maximum urine flow rate was（ 7 ± 5） ml / s. Conclusions： Laparoscopic radical resection of bladder carcinoma and ileal neobladder in situ with reservation of prostatic urethra has advantages of few trauma and complications,little bleeding,complete retention of male sexual function,its effect is satisfactory. Under the premise of strict operative indication,this procedure has favorable clinical application value,but the long-term effect of tumor control still needs to be further observed.

关 键 词：膀胱肿瘤 尿流改道术 腹腔镜检查 前列腺 

分 类 号：R737.14[医药卫生—肿瘤]