论文部分内容阅读
目的:探讨腹腔镜根治性膀胱切除术的临床价值。方法:对具有手术指征的15例膀胱癌患者施行腹腔镜根治性膀胱切除术治疗。常规建立5个工作通道,在腹腔镜下行双侧盆腔淋巴结清扫及膀胱全切除,自下腹切口取出标本。4例行回肠膀胱术,11例行原位回肠新膀胱术。观察手术时间、术中出血量、输血量、术后肠道功能恢复、尿外渗、尿瘘及术后腹腔并发症发生以及手术后效果。结果:15例手术成功。腹腔镜下根治性膀胱切除手术时间150～300 min;腹腔镜下新膀胱与后尿道吻合手术时间30～100 min;手术总时间300～660 min,术中出血500～1 200 mL;术中输血0～800 mL。2例术后出现急迫性尿失禁,经锻练后控尿满意;其余患者恢复良好。无腹腔并发症发生。结论:腹腔镜根治性膀胱切除术具有创伤小、术中操作精细、盆腔淋巴结清扫彻底、术后恢复快、并发症少的优点。
Objective: To investigate the clinical value of laparoscopic radical cystectomy. Methods: Fifteen cases of bladder cancer with surgical indications underwent laparoscopic radical cystectomy. Routine establishment of five working channels, laparoscopic bilateral pelvic lymph node dissection and bladder resection, removed from the lower abdominal incision specimens. 4 cases of ileal bladder surgery, 11 cases of ileal neo-bladder surgery. The operation time, intraoperative blood loss, blood transfusion, postoperative intestinal function recovery, urine extravasation, urinary fistula and postoperative abdominal complications and postoperative effects were observed. Results: 15 cases were successful. Laparoscopic radical cystectomy for 150 to 300 minutes; laparoscopic neo-bladder and posterior urethral anastomosis for 30 to 100 minutes; total operation time from 300 to 660 minutes; intraoperative blood loss from 500 to 1,200 ml; intraoperative blood transfusion 0 ~ 800 mL. Two cases of urgency urinary incontinence after surgery, controlled by urine satisfaction; the rest of the patients recovered well. No abdominal complications occurred. Conclusions: Laparoscopic radical cystectomy has the advantages of small trauma, fine operation, thorough pelvic lymph node dissection, quick recovery after operation and few complications.