腹腔镜全膀胱切除术治疗膀胱憩室癌4例报告及文献复习  

Laparoscopic total cystectomy in the treatment of carcinoma of bladder diverticulum: a report of 4 cases and review of the literature

作　　者：孙吉[1] 林连祥[1] 范祎[1] 於裕福[1] 华棋燕 陈丽锋[1] 

机构地区：[1]浙江萧山医院,浙江杭州311202

出　　处：《腹腔镜外科杂志》2015年第11期812-814,共3页Journal of Laparoscopic Surgery

摘　　要：目的:探讨膀胱憩室癌的临床特点及腹腔镜全膀胱切除术治疗膀胱憩室癌的可行性与安全性。方法:回顾分析2015年1月前4例因膀胱憩室癌行腹腔镜膀胱憩室癌根治术患者的临床资料,其中男3例,女1例,中位年龄62岁,术前均行膀胱镜成功活检,病理提示均为肌层浸润性膀胱憩室癌。B超、胸部CT、ECT等检查未发现远处脏器及骨转移,CT尿路成像提示双侧上尿路成像正常,无肾积水、囊肿及肿瘤。4例患者均行腹腔镜全膀胱切除术,其中3例行回肠代膀胱尿流改道术,1例行双侧输尿管皮肤造口术。结果:手术均获成功,无中转开放手术。术后病理结果均为尿路上皮癌,分级分别为G1级1例,G2级2例,G3级1例。4例患者术后中位随访时间为39个月,其中1例于术后31个月死于远处肿瘤转移,余3例患者均无瘤生存。结论:影像学、膀胱镜检查及病理活检是确诊膀胱憩室癌的重要方法。对于肌层浸润的膀胱憩室癌的治疗应采取根治性切除,腹腔镜全膀胱切除术治疗膀胱憩室癌安全、有效。Objective： To explore the clinical characteristics of carcinoma in bladder diverticulum and evaluate the safety and feasibility of laparoscopic radical cystectomy for carcinoma of bladder diverticulum. Methods： Clinical data of 4 patients with carcinoma in bladder diverticulum who underwent laparoscopic radical cystectomy before Jan. 2015 were retrospectively analyzed,including 3 males and 1 female,with a median age of 62 years old. All patients were examined by cystoscopy and confirmed muscle-invasive cancer in bladder diverticulum. Type-B ultrasound,chest CT,ECT displayed that distant organs and bone metastasis were not found,CTU showed normal bilateral upper urography without hydronephrosis,cyst or tumor. Three cases underwent laparoscopic radical cystectomy and ileal conduit,one case underwent laparoscopic radical cystectomy and uretero-ureterocutaneostomy. Results： All operations were successful without conversion to open operation. Postoperative pathology suggested urothelium carcinoma. 1 case was in G1,2 cases in G2,1 case in G3. The patients were followed up for a median of 39 months after operation,and one of them died of distant metastasis after operation for 31 months,the other patients survived without tumor. Conclusions： Imageology,cystoscopy and biopsy are important examinations to confirm carcinoma in bladder diverticulum. Surgical treatment should be used for treatment and radical resection should be performed for those with muscle-invasive cancer in bladder diverticulum,and laparoscopic radical cystectomy for carcinoma in bladder diverticulum is safe and efficient.

关 键 词：膀胱憩室肿瘤 全膀胱切除术 腹腔镜检查 

分 类 号：R737.14[医药卫生—肿瘤]