腹腔镜挽救性膀胱切除术治疗膀胱部分切除术后膀胱癌复发的疗效分析  

The clinical study of laparoscopic radical cystectomy for bladder cancer aftar partial cystectomy

作　　者：刘竞[1] 凌敏 安宇 罗一钊 黄建林 马志伟 李利军 邱明星 Liu Jing;Ling Min;An Yu;Luo Yizhao;Huang Jianlin;Ma Zhiwei;Li Lijun;Qiu Mingxing(Department of Urology,Sichuan Provincial People's Hospital,University of Electronic Science and Technology of China,Chengdu 610072,China;Department of Anesthesia Operation Center,Sichuan Provincial People's Hospital,University of Electronic Science and Technology of China,Chengdu 610072,China)

机构地区：[1]电子科技大学附属医院四川省人民医院泌尿外科,成都610072 [2]电子科技大学附属医院四川省人民医院麻醉手术中心,成都610072

出　　处：《中华泌尿外科杂志》2021年第4期274-277,共4页Chinese Journal of Urology

基　　金：四川省卫生和计划生育委员会普及应用项目(18PJ452)。

摘　　要：目的探讨腹腔镜挽救性膀胱切除术治疗膀胱部分切除术(PC)后膀胱癌复发的疗效。方法回顾性分析2016年3月至2020年8月四川省人民医院收治的30例PC后复发行腹腔镜挽救性膀胱切除术患者的临床资料。男24例,女6例。中位年龄62.5(45.5~82.5)岁。30例中6例PC时行盆腔淋巴结清扫(PLND)。PC术后病理诊断均为高级别尿路上皮癌,病理分期pT_(2~3b)N_(0)M_(0)期。术后5例行吉西他滨+顺铂辅助化疗,6例行辅助放疗,13例行辅助放化疗;30例均行膀胱维持灌注治疗。PC术后肿瘤局部复发中位时间9(5~29)个月,病理类型均为浸润性高级别乳头状尿路上皮癌,cT_(2~4)N_(0)M_(0)期;肿瘤直径中位值3.5(2.5~4.5)cm,肿瘤数量中位值2(1~3)个。复发后均行腹腔镜挽救性膀胱切除术:于右侧髂外动脉分叉处找到输尿管游离至膀胱壁,左侧从髂总动脉末端开始游离,顺序游离膀胱后、前壁,缝扎背深血管复合体,切断膀胱侧血管蒂,切断尿道后切除膀胱。采用标准PLND,既往已行PLND者不再清扫闭孔及髂血管周围淋巴结,仅向上清扫至腹主动脉分叉处,包括髂总血管、腹主动脉分叉及下腔静脉周围淋巴组织,以及骶骨前淋巴结。结果本组30例手术均顺利完成。手术时间平均270(240~310)min,术中失血量中位值180(50~300)ml,围手术期无输血病例。淋巴结清扫数量中位值18(10~27)枚;4例淋巴结阳性,其中3例为2枚闭孔淋巴结阳性,1例为3枚闭孔及髂外淋巴结阳性。无严重术中并发症发生,无淋巴漏发生。引流管留置时间中位值4(3~7)d,住院时间中位值9(7~20)d。术后病理诊断均为浸润性高级别乳头状尿路上皮癌,病理分期pT_(2~4a)N_(0)~2M_(0)期。术后13例行辅助性化疗。术后中位随访时间23(3~31)个月,2例盆腔复发,1例腹膜后淋巴结远处转移,此3例予辅助性化疗及放疗。结论腹腔镜挽救性膀胱切除术手术并发症少,复发转移率低,是PC术后膀胱癌复发Objective To discuss the clinical efficacy of laparoscopic radical cystectomy in the treatment of bladder cancer after partial cystectomy.Methods The clinical data of 30 patients who underwent laparoscopic radical cystectomy after PC in Sichuan Provincial People's Hospital from March 2016 to August 2020 were retrospectively analyzed.Including 24 males and 6 females with an average age was 62.5(45.5-82.5)years.6 out of 30 cases underwent pelvic lymph node dissection during PC.All patients had definite pathological diagnosis for the high-grade urothelial carcinoma after PC,and the tumor staging was pT_(2-3b)N_(0)M_(0).5 patients received postoperative adjuvant chemotherapy with gemcitabine and cisplatin,6 received postoperative adjuvant radiotherapy,13 received postoperative adjuvant radiotherapy and chemotherapy,and all patients were received maintenance intravesical instillation.Median time for local tumor recurrence after PC was 9(5-29)months,all patients had pathological diagnosis for the high-grade papillary urothelial carcinoma,cT_(2-4)N_(0)M_(0) stage.The average tumor diameter was 3.5(2.5-4.5)cm,an average number of tumors was 2(1-3).Laparoscopic salvage cystectomy was performed after recurrence.General anesthesia,supine position,5 ports were inserted through the abdominal approach.Standard pelvic lymph node dissection(PLND)was used to clean the pelvic lymph nodes.Those who had underwent PLND no longer clean the obturator and peripheral iliac vessels,but including the common iliac vessel and the bifurcation of the abdominal aorta and lymphatic tissues around the inferior vena cava,as well as the presacral lymph nodes.Results All 30surgeries were successfully performed.The average operative time was 270(240-310)min,average estimated intraoperative blood loss was 180(50-300)ml,and there was no blood transfusion during the perioperative period.The average number of lymph nodes dissected was 18(10-27).There were 4 cases with positive lymph nodes,of which 3 cases were positive for 2 obturator lymph nodes,and 1 c

关 键 词：膀胱肿瘤 腹腔镜 挽救性膀胱切除 膀胱部分切除术 复发 

分 类 号：R737.14[医药卫生—肿瘤]