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目的探讨完全腹腔镜下膀胱癌根治性全切除+尿流改道术的临床可行性,并总结手术技巧。方法对69例膀胱癌患者行完全腹腔镜下膀胱癌根治性全切除+尿流改道术(包括回肠膀胱术和原位回肠新膀胱术),其中行完全腹腔镜下膀胱癌根治性全切除+回肠膀胱术22例,行完全腹腔镜下膀胱癌根治性全切除+原位回肠新膀胱术47例。结果 69例患者的手术均获成功。完全腹腔镜下膀胱癌根治性全切除+回肠膀胱术组的手术时间为(240±28)min,术中出血量为(380±120)mL,术后肠功能恢复时间为(2.5±1.2)d,术后住院时间为(7.7±0.9)d,术后无肠瘘、尿瘘等并发症发生。完全腹腔镜下膀胱癌根治性全切除+原位回肠新膀胱术组的手术时间为(333±32)min,术中出血量为(680±200)mL,术后肠功能恢复时间为(3.6±1.1)d,术后住院时间为(24.0±3.2)d;术后1例患者发生回肠吻合口瘘,遂行开放吻合口修补术。所有患者经术后病理学检查证实均为膀胱尿路上皮癌,病理分级Ⅰ级10例、Ⅱ级29例、Ⅲ级30例,淋巴结清扫数目为(17.0±6.3)枚,淋巴结阳性率为7.2%(5/69)。术后随访3~24个月,平均随访时间为(14.7±5.3)个月,无1例患者发生肿瘤复发或转移。结论完全腹腔镜下膀胱癌根治性全切除+尿流改道术可减少手术创伤,术中解剖结构显露较满意,有利于患者术后恢复;但手术难度较大,须熟练掌握各种腹腔镜操作技术后方可进一步开展。
Objective To investigate the clinical feasibility of total laparoscopic radical resection of bladder cancer and urinary diversion and to summarize the surgical techniques. Methods Totally 69 patients with bladder cancer undergoing total laparoscopic radical resection of bladder cancer + urinary diversion (including ileal bladder surgery and ileal neo-bladder surgery) were performed complete laparoscopic radical resection of bladder cancer + Twenty-two patients underwent ileal bladder surgery, totally radical laparoscopic radical resection of bladder cancer plus ileal neo-bladder surgery in 47 patients. Results 69 cases of patients were successful. The operative time of total laparoscopic radical resection of bladder cancer + ileal bladder surgery group was (240 ± 28) min, the amount of blood loss was (380 ± 120) mL and the recovery time of intestinal function was (2.5 ± 1.2) d, postoperative hospital stay was (7.7 ± 0.9) d, postoperative no intestinal fistula, urinary fistula and other complications occurred. Total laparoscopic radical resection of bladder cancer + ileal neo-neo-bladder surgery was (333 ± 32) min, with an intraoperative blood loss of (680 ± 200) mL and postoperative recovery of intestinal function was (3.6 ± 1.1) d, and the postoperative hospital stay was (24.0 ± 3.2) days. One patient had ileostomy fistula after operation and anastomotic repair was performed. All patients were confirmed by postoperative pathological examination of bladder urothelial carcinoma, pathological grade Ⅰ grade in 10 cases, Ⅱ grade 29 cases, Ⅲ grade 30 cases, the number of lymph node dissection (17.0 ± 6.3) pieces, the positive rate of lymph nodes 7.2 % (5/69). The patients were followed up for 3 to 24 months. The average follow-up time was (14.7 ± 5.3) months. None of the patients had tumor recurrence or metastasis. Conclusions Total laparoscopic radical resection of bladder cancer + urinary diversion can reduce the surgical trauma, surgery anatomy revealed satisfactory, is conducive to postoperative recovery; but the operation is more difficult, must be proficient in various laparoscopic operation Technology can be further developed.