腹腔镜下膀胱癌根治术中完全腹膜外经皮输尿管造口术

目的 介绍一种腹腔镜下膀胱癌根治术中，完全腹膜外输尿管造口新技术，评价其治疗一例T₄期高级别膀胱浸润性尿路上皮癌患者的疗效。方法 以1例75岁男性高级别膀胱浸润性尿路上皮癌(T₄N₀M₀)为例，介绍一种腹腔镜下膀胱根治性切除术中，完全腹膜外输尿管造口技术的4个关键步骤，包括游离输尿管(将左侧输尿管游离足够长度)、汇集两根输尿管(腹腔镜下将左侧输尿管经直肠后方拉至右侧)、建立腹膜外通道(游离扩大右侧腹膜外间隙，将两根输尿管从此通道拉出)、腹膜重建。结果 手术共耗时(从消毒铺单开始计时到输尿管造口结束)248 min，出血量100 ml，造口处可见清晰尿液流出，患者术后住院时间8 d。结论 本例输尿管造口术是一种完全腹腔镜下经皮输尿管造口技术的尝试，相较于传统输尿管造口术而言，该术式创伤小，出血量少，术后恢复时间缩短。对于需要永久性尿流改道，但心肺功能差，手术风险高或没有机会做肠道尿流改道的患者，该术式是一种可行且安全的尿流改道方式。

Complete extraperitoneal ureterostomy during laparoscopic radical resection of bladder cancer: A technical report

ObjectiveTo describe a new technique of unilateral complete extraperitoneal ureterostomy during laparoscopic radical resection of bladder cancer, and evaluate the efficacy of this technique in the treatment of a patient with grade T₄ infiltrating urothelial carcinoma of the bladder. MethodsA case study of a 75-year-old man with a malignant tumor of the bladder (T₄N₀M₀) was conducted to introduce the four key steps of a unilateral complete extraperitoneal ureterostomy during radical cystectomy by laparoscope, which include separate ureter (separate the left ureter into a sufficient length), collect two ureters (pull the left ureter behind the rectum to the right), establish an extraperitoneal passage (expand the right extraperitoneal space, pull the two ureters out of the passage), and reconstruct the peritoneum. ResultsThe total operation time was 248 minutes (from the start of the disinfection to the end of the ureterostomy), the blood loss was 100 ml, clear urine outflow was visible at the stoma, and the postoperative hospital stay of the patient was 8 days. ConclusionThis is an attempt at a complete laparoscopic ureterostomy with less trauma, less bleeding and shorter postoperative recovery time than conventional ureterostomy. This is a feasible and safe urinary diversion for patients who need permanent urinary diversion, but have poor cardiopulmonary function, high surgical risk, or no opportunity for intestinal urinary diversion.