112例腹膜外途径腹腔镜膀胱全切和原位回肠膀胱经验总结  

Extraperitoneal laparoscopic radical cystectomy and extraperitoneal ileal orthotopic neobladder:clinical experience of 112 patients

作　　者：李雪禹 张宗亮[1] 张玉莲 杨瀚 朱冠群[1] 赵凯[1] 尹心宝[1] 王振林[1] 种丽强 刘杰[1] 李晨[1] 隋元明 李兆峰 王庆雷 王科[1] LI Xueyu;ZHANG Zongliang;ZHANG Yulian;YANG Han;ZHU Guanqun;ZHAO Kai;YIN Xinbao;WANG Zhenlin;CHONG Liqiang;LIU Jie;LI Chen;SUI Yuanming;LI Zhaofeng;WANG Qinglei;WANG Ke(Department of Uolorgy,the Affiliated Hospital of Qnigdao University,Qingdao,Shandong,266000,China;Department of Gynecology,the Affiliated Hospital of Qnigdao University,Qingdao,Shandong,266000,China)

机构地区：[1]青岛大学附属医院泌尿外科,山东青岛266000 [2]青岛大学附属医院妇科,山东青岛266000

出　　处：《临床泌尿外科杂志》2022年第11期821-826,共6页Journal of Clinical Urology

基　　金：国家自然科学基金资助项目(No:31971191)。

摘　　要：目的:探讨腹膜外途径腹腔镜下根治性膀胱全切术(ELRC)和原位回肠膀胱术(EION)的手术方法,评价其临床效果。方法:回顾性分析2018年3月—2022年3月在青岛大学附属医院行ELRC和EION的112例患者的临床资料,包括手术方式、手术时间、术中出血量、术后并发症等,对ELRC和EION的手术方法及治疗效果进行分析总结。结果:112例患者均手术顺利,无术中转开放手术。手术时间为(229.08±37.97)min,术中出血量为(182.13±68.79)mL,住院时间为(13.22±4.75)d。术后病理回报13例为原位癌;T_(a)~T_(1)17例,T_(2)62例,T_(3)15例,T_(4)5例;3例患者同时存在前列腺癌。随访(16.17±9.14)个月,主要并发症为泌尿道感染与淋巴漏,术后肠梗阻发生率仅为2.68%。患者大部分可原位腹压排尿,并在术后6个月获得白天控尿。结论:ELRC和EION具有对腹腔干扰小、术后肠道功能恢复快及术后并发症发生率低等优点。标准的操作流程可明显缩短手术时间、降低手术难度,是临床上医生可供选择的手术。Objective:To explore the methods of extraperitoneal laparoscopic radical cystectomy(ELRC)and extraperitoneal ileal orthotopic neobladder(EION),and evaluate their clinical outcomes.Methods:The clinical data of 112 patients in the Affiliated Hospital of Qingdao University who underwent ELRC and EION from March 2018 to March 2022 were retrospectively analyzed and summarized,including the surgical method,operation time,intraoperative blood loss,and follow-up of postoperative complications.Results:All 112 patients underwent successful surgery without conversion to open.The operation time was(229.08±37.97)min,the intraoperative blood loss was(182.13±68.79)mL,and the hospital stay was(13.22±4.75)d.Postoperative pathological results showed that 13 cases were carcinoma in situ,17 cases were T_(a)-T_(1),62 cases were T_(2),15 cases were T_(3),and 5 cases were T_(4).Three patients had prostate cancer simultaneously.The follow-up time was(16.17±9.14)months.The main complications were urinary tract infection and lymphorrhagia.The incidence of postoperative intestinal obstruction was 2.68%.Most patients were able to urinate with in situ abdominal pressure and achieved daytime continence 6 months after surgery.Conclusion:The main advantages of ELRC and EION were less interference to the abdominal cavity,quick recovery of postoperative intestinal function,and low incidence of postoperative complications.Procedural operation can significantly shorten the operation time and reduce the difficulty of operation,so it is an optional operation for surgeons.

关 键 词：腹膜外 腹腔镜 膀胱癌 新膀胱 并发症 

分 类 号：R737.14[医药卫生—肿瘤]