论文部分内容阅读
目的探讨腹腔镜根治性膀胱全切+原位回肠新膀胱术的手术方法和经验。方法回顾分析2011年3月-2014年10月该院14例浸润性膀胱癌患者的临床资料。结果 13例成功施行了腹腔镜根治性膀胱全切+原位回肠新膀胱术,1例因术中膀胱内肿瘤出血增加术野无法显露而中转开放手术。12例在直视下行新膀胱尿道间断吻合,2例在腹腔镜下采用单针连续缝合法行新膀胱尿道吻合。手术平均时间444 min,术中平均出血量490 ml。术后病理提示12例为膀胱尿路上皮癌,其中1例伴部分鳞状细胞癌,2例为膀胱腺癌。2例患者术后出现尿漏,经保守治疗后治愈,1例术后出现尿失禁。术后随访6~56个月,3例死于肿瘤远处转移,1例目前发生肿瘤颅内转移。其余10例目前仍无瘤生存,其中1例术后1年出现尿道内口狭窄,经行尿道狭窄内切开术后治愈。10例患者目前控尿功能恢复良好,新膀胱容量约300 ml。结论腹腔镜根治性膀胱全切+原位回肠新膀胱术治疗膀胱癌疗效确切、安全、创伤小及术后恢复快,可作为临床浸润性膀胱癌的首选治疗方法。
Objective To investigate the surgical method and experience of laparoscopic radical cystectomy + ileal neo-bladder surgery. Methods The clinical data of 14 patients with invasive bladder cancer from March 2011 to October 2014 were retrospectively analyzed. Results 13 patients underwent laparoscopic radical cystectomy + ileocecal neobladder successfully, and 1 patient underwent open surgery due to intraoperative intravesical tumor hemorrhage which could not be seen in the operative field. Twelve patients underwent indirect anastomosis of the new bladder and urethra under direct vision, and two patients underwent laparoscopic surgery with a single needle continuous suture. The average operation time was 444 minutes and the average blood loss during operation was 490 ml. Postoperative pathology prompted 12 cases of bladder urothelial carcinoma, including 1 case with squamous cell carcinoma, 2 cases of adenocarcinoma of the bladder. Urine leakage occurred in 2 patients and was cured after conservative treatment. Urinary incontinence occurred in 1 patient. All cases were followed up for 6 to 56 months, 3 died of distant metastasis and 1 had intracranial metastases. The remaining 10 cases are still no tumor-free survival, of which 1 case of urethral stricture occurred within 1 year after surgery, cured by urethral stricture incision. Urinary function was well recovered in 10 patients with a new bladder capacity of about 300 ml. Conclusions Laparoscopic radical cystectomy + ileal neo-bladder surgery is effective, safe, minimally invasive and rapid after operation. It can be used as the first choice for clinical treatment of bladder cancer.