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目的:探讨改良式四孔法腹腔镜根治性膀胱切除加回肠膀胱术的临床疗效及其应用价值。方法:2014年1月~2015年6月期间由单一术者应用改良式四孔法腹腔镜根治性膀胱切除加回肠膀胱术治疗膀胱癌患者31例,其中男26例,女5例,年龄:47~78岁,平均63.7岁。传统四孔法行根治性膀胱切除(女性包括子宫、双侧附件及部分阴道前壁)及双侧盆腔淋巴结清扫。延长右侧12mmTrocar切口取出标本(女性自阴道取标本)及拟截取的肠管进行肠道操作,缩窄此切口行回肠膀胱腹壁造口。结果:所有手术均顺利完成,无中转开放。手术时间:240~420 min,平均307.7min;出血量:100~500ml,平均243.5ml;术中输血2例;所有标本切缘病理检查均为阴性。术后2~4d下地活动,术后排气时间4~7d。无尿瘘及肠瘘等严重并发症。2例出现不完全性肠梗阻,保守治疗后治愈。1例拔除单J管后出现尿路感染,双肾积水,保守治疗后治愈。结论:改良式四孔法腹腔镜根治性膀胱切除加回肠膀胱术是在传统四孔法的基础上一次良好的改进,减少了切口,更加美观,术后恢复好,值得推广和应用。
Objective: To investigate the clinical efficacy and the value of modified four-hole laparoscopic radical cystectomy plus ileal bladder surgery. Methods: From January 2014 to June 2015, a total of 31 patients with bladder cancer were treated with radical four-hole laparoscopic radical cystectomy and ileal bladder surgery from a single surgeon. There were 26 males and 5 females with a mean age of 47 ~ 78 years old, average 63.7 years old. Traditional four-hole method of radical cystectomy (women, including the uterus, bilateral annex and part of the anterior vaginal wall) and bilateral pelvic lymph node dissection. Extend the right 12mmTrocar incision specimens (female from the vagina to take specimens) and intestinal intestine intends to intercept the operation, narrowing the incision ileal bladder abdominal wall stoma. Results: All the operations were successfully completed and there was no transfer to open. Operation time: 240 ~ 420 min, an average of 307.7min; bleeding volume: 100 ~ 500ml, an average of 243.5ml; 2 cases of intraoperative blood transfusions; all specimens were negative for pathological examination. After 2 ~ 4d activities under the ground, postoperative exhaust time 4 ~ 7d. No urinary fistula and intestinal fistula and other serious complications. 2 cases of incomplete intestinal obstruction, cured after conservative treatment. One case of single J tube removed after urinary tract infection, hydronephrosis, conservative treatment after cure. Conclusions: The modified four-hole laparoscopic radical cystectomy and ileal vesiculation is a good improvement on the basis of the traditional four-hole method, reducing the incision, more beautiful, good postoperative recovery, and worthy of promotion and application.