腹腔镜膀胱癌根治—原位回肠新膀胱术(附5例报告)

目的探讨腹腔镜膀胱癌根治—原位回肠新膀胱术的临床疗效。方法 2008年11月至2011年4月,采用5点穿刺经腹入路,先行腹腔镜下膀胱癌根治,继而体外构建回肠新膀胱,最后腹腔镜下行新膀胱尿道吻合,实施腹腔镜膀胱癌根治—原位回肠新膀胱术5例。皆为男性,平均年龄67岁。结果手术时间420～600min,平均480min,术中失血量350～800ml,平均400ml。术后淋巴结及手术切缘均阴性。随访3～24个月,除1例有轻度夜间尿失禁外,其余患者均昼夜控尿良好。代膀胱充盈良好,容量200～350ml,平均270ml。平均最大尿流率12ml/s。1例出现勃起功能障碍。结论腹腔镜膀胱癌根治—原位回肠新膀胱术创伤小、出血少、并发症少且疗效满意。

Laparoscopic radical cystectomy with orthotopic ileal neobladder(report of 5 cases)

Objective To evaluate the clinical efficacy of laparoscopic radical cystectomy with orthotopic ileal neobladder.Methods From November 2008 to April 2011,5 patients underwent laparoscopic radical cystectomy with orthotopic ileal neobladder.All of them were male.Mean age was 67 years old.Five-port transperitoneal approach was applied.The standard bilateral pelvic lymphadenectomy was performed first,then radical cystectomy was completed laparoscopically.The construction of the ileal neobladder and the anastomosis of ureter-neobladder were performed extracorporeally.The neobladder was anastomosed to the urethral stump under laparoscopy.Results The mean operative time was 480 min(420-600 min).The mean intraoperative blood loss was 400 ml(350-800 ml).The lymph nodes as well as the surgical margins were negative for tumor.The follow-up period was 3-24 months.All cases had satisfactory urinary continence day and night,except 1 case mildly incontinent at night.The mean reservoir capacity was 270 ml(200-350 ml).The average maximum urinary flow rate was 12 ml/s.1 case of erectile dysfunction.Conclusions Laparoscopic radical cystectomy with orthotopic ileal neobladder is minimally invasive,less bleeding,fewer complications and effective for the surgical treatment of bladder cancer patients.