基于膜解剖之四纵两横六层面法的腹腔镜根治性膀胱切除术的临床应用价值(“大家泌尿网”观看手术视频)  

Clinical value of“four longitudinal,two transverse planes”method of membrane anatomy in laparoscopic radical cystectomy

作　　者：保东平 钟培锋 伍国豪 李浩民 陈东江 胡先国 吴炳权[3] 陈征 郭泽雄[1] 叶东明 赖彩永[1,2,5] BAO Dongping;ZHONG Peifeng;WU Guohao;LI Haomin;CHEN Dongjiang;HU Xianguo;WU Bingquan;CHEN Zheng;GUO Zexiong;YE Dongming;LAI Caiyong(Department of Urology,The First Affiliated Hospital of Jinan University,Guangzhou 510630;Department of Urology,The Sixth Affiliated Hospital of Jinan University,Dongguan 523570;Department of Urology,The First People’s Hospital of Zhaoqing,Zhaoqing 526000;Department of Urology,Yangxi People’s Hospital,Yangjiang 529800;Institute of Urology,The Sixth Affiliated Hospital of Jinan University,Dongguan 523570,China)

机构地区：[1]暨南大学附属第一医院泌尿外科,广东广州510630 [2]暨南大学附属第六医院泌尿外科,广东东莞523570 [3]肇庆市第一人民医院泌尿外科,广东肇庆526000 [4]阳西县人民医院泌尿外科,广东阳江529800 [5]暨南大学附属第六医院泌尿外科研究所,广东东莞523570

出　　处：《现代泌尿外科杂志》2024年第5期399-405,共7页Journal of Modern Urology

基　　金：东莞市社会发展科技重点项目(No.20231800935912);阳江市卫生健康局科技计划项目(No.阳卫健2021036);阳江市科学技术局医疗卫生类科技计划项目(No.SF2021212);暨南大学医学联合基金项目(No.YXJC2022009)。

摘　　要：目的探讨基于膜解剖的四纵两横六层面法的腹腔镜根治性膀胱切除术在膀胱癌治疗中的临床价值。方法回顾性分析暨南大学第一附属医院和第六附属医院泌尿外科2015年1月—2022年6月因膀胱癌行腹腔镜根治性膀胱切除术的51例患者的临床资料,按照“四纵两横六层面法”的手术思路,采用膜解剖技术完成膀胱根治性切除。其中术前性功能正常的男性患者行预先盆神经丛显露的保留性神经的膀胱癌根治术。结果本组患者手术均顺利完成,无中转开放手术。手术时间(502.52±108.99)min,术中失血量(275.96±155.18)mL,术后进食时间(4.14±2.41)d,术后住院时间(16.37±4.85)d,淋巴结清扫数量(17.98±11.48)枚,平均随访(30.27±19.39)个月。在末次随访中,患者均未出现Clavien≥3级的并发症,总体生存率(OS)、肿瘤特异性生存率(TSS)和无复发生存率(RFS)的比率分别为82.4%、92.2%和88.2%。淋巴结阳性和阴性患者的OS分别为60.0%和84.8%、RFS为60.0%和91.3%。行预先显露盆神经丛的保留性神经的膀胱癌根治术患者中18例采用原位新膀胱术,其日间及夜间尿控率分别为83.3%和72.2%,17例在术后6个月内恢复了性功能。结论基于筋膜解剖的四纵两横六层面法腹腔镜膀胱根治性切除术切实可行,手术步骤程序化、肿瘤控制效果好、出血少、术后并发症少、术后恢复快。Objective To explore the clinical value of laparoscopic radical cystectomy based on fascia anatomy for bladder cancer treatment.Methods The clinical data of 51 patients with bladder cancer who underwent 3D laparoscopic radical cystectomy during Jan.2015 and Jun.2022 were retrospectively analyzed.The surgery was performed based on membrane anatomy technology along four longitudinal and two transverse planes to complete the radical cystectomy.The pelvic plexus was preserved for patients with normal preoperative sexual function.Results All surgeries were completed without conversion to open operation.The mean operation time was(502.52±108.99)min,mean intraoperative blood loss was(275.96±155.18)mL,mean postoperative drainage time was(4.14±2.41)d,and the mean postoperative hospital stay was(16.37±4.85)d.The mean number of lymph nodes removed was(17.98±11.48).The mean postoperative follow-up was(30.27±19.39)months.At the last follow-up,no Clavien≥grade 3 complications were observed.The estimated overall survival(OS),tumor-specific survival(TSS),and recurrence-free survival(RFS)were 82.4%,92.2%,and 88.2%,respectively.The lymph node positive patients had shorter OS and RFS(60.0%,60.0%)than the lymph node negative patients(84.8%,91.3%).Among the 19 male patients who underwent radical cystectomy with pre-exposure and preservation of pelvic plexus,daytime and nocturnal continence rate were 83.3%and 72.2%,respectively,and 17 patients recovered potency within 6 months postoperatively.Conclusion Laparoscopic radical cystectomy based on fascia anatomy is safe and effective in laparoscopic radical cystectomy,with standardized surgical procedure,satisfactory oncological outcomes,little hemorrhage,few complications and fast recovery.

关 键 词：膜解剖 膀胱癌 根治性膀胱切除术 四纵两横六层面法 

分 类 号：R737.14[医药卫生—肿瘤]