改良腹腔镜下根治性膀胱切除＋盆腔淋巴结清扫术治疗女性膀胱癌的安全性和有效性  

Safety and feasibility of modified laparoscopic radical cystectomy and standard pelvic lymph node dissection for female bladder cancer patients

作　　者：于浩[1] 薛苗新 李锴文[1] 刘皓[1] 范新祥[1] 林天歆[1] 黄健[1] 

机构地区：[1]中山大学孙逸仙纪念医院泌尿外科,广州510120

出　　处：《中华泌尿外科杂志》2017年第5期337-341,共5页Chinese Journal of Urology

摘　　要：目的探讨改良腹腔镜下根治性膀胱切除＋标准盆腔淋巴结清扫术治疗女性膀胱癌的安全性及有效性。方法回顾性分析2003年6月至2016年1月我院收治的41例行腹腔镜下根治性膀胱切除＋标准盆腔淋巴结清扫术的女性膀胱癌患者的资料。根据手术方式不同将病例分为改良组（16例）和传统组（25例）。改良组平均年龄（62.2±11.5）岁；中位体重指数20.7 kg/m2（18.4，22.2）kg/m^2；美国麻醉医师协会（American Society of Anesthesiologists，ASA）分级≤Ⅱ级9例（56.2%），Ⅲ级7例（43.8%）。传统组平均年龄（60.4±12.9）岁；中位体重指数21.7 kg/m^2（18.4，23.1）kg/m2；ASA分级≤Ⅱ级15例（60%），Ⅲ级10例（40%）。术前临床分期改良组15例≤cT2期，1例为cT3期；传统组22例≤cT2期，3例为cT3期。两组手术均采用全麻。传统组在切除膀胱时先分离直肠子宫平面，打开后穹窿，离断膀胱侧蒂、子宫主韧带，离断阴道侧壁至膀胱颈水平，离断尿道后将膀胱及子宫、阴道前壁一同切除，之后行标准盆腔淋巴结清扫术。改良组游离输尿管后先行双侧标准盆腔淋巴结清扫术，之后分离膀胱子宫平面、显露阴道前壁，再离断膀胱侧蒂、分离膀胱前壁，显露膀胱颈离断尿道后先切除膀胱，尽量靠近子宫颈切开子宫前壁，切断阴道侧壁及后壁。改良组中1例保留子宫及卵巢、2例保留子宫、1例保留卵巢。分析比较两组的手术相关数据及术中、术后早期并发症情况。结果两组手术均顺利完成，无中转开放手术病例，无围手术期死亡病例。改良组和传统组尿流改道方式：原位回肠新膀胱术分别为10例和19例，回肠通道术分别为5例和3例，输尿管皮肤造口术分别为1例和3例，两组的尿流改道方式构成比差异无统计学意义（P〉0.05）。改良组中位手术时间为290 min（265，335） min；常规组为315 min（270，38Objective To investigate the safety and efficacy of the modified laparoscopic radical cystectomy and standard pelvic lymph node dissection for female bladder cancer patients. Methods Fortyone female patients with bladder cancer who underwent laparoscopic radical cystectomy（LRC） and standard pelvic lymph node dissection（sPLND） in our hospital from June 2003 to January 2016 were retrospectively analyzed. The patients were divided into two groups according to the surgical procedure. There were 15 patients with ≤cT2 tumor and 1 patient with cT3 in the modified group. The average age was （62.2 ± 11.5 ） years. The median BMI was 20.7 kg/m^2 ,ranging 18.4 to 22.2 kg./m^2 ;The ASA level was less than 11 in 9 （56.2%） cases and was level m in 7 （43.8%） cases. There were 22 patients with ≤ cT2 tumor and 3 patients with cT3 in the traditional group. The average age was （60.4 ± 12.9 ）years. The median BMI was 21.7 kg/m^2 ,ranging 18.4 to 23.1 kg/m^2. ASA was less than level Ⅱ in 15（60.0% ） cases and level Ⅲ in 10（40.0% ） cases. All operations are performed under general anesthesia. In the traditional group, the plane between rectus and uterus is separated first. Then open the posterior cervical fornix and cut off the lateral bladder pedicle, cardinal ligament of uterus and urethra. The bladder and uterus are removed together. The sPLND is performed at last. In the modified group, the sPLND is performed first. Then separate the bladder and uterus until the anterior wall of the vagina can be exposed. The bladder and uterus are removed separately. Data of the operation and the complications were collected and analyzed. Results All patients were performed the operation successfully. No open conversion was recorded during the operation. No patient died during the peripheral operative phase. In modified group, 10 patients received orthotopic ileal neobladder （OIN）, 5 patients received ileal conduit and 1 patient received ureterostomy. In traditional group, 19 patients received OIN, 3 p

关 键 词：女性 腹腔镜 根治性膀胱切除术 淋巴结清扫术 

分 类 号：R737.14[医药卫生—肿瘤]