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目的:探讨腹腔镜下根治性膀胱全切除回肠膀胱术的临床可行性,并总结手术技巧。方法:对3例膀胱癌患者行腹腔镜下根治性膀胱全切术,并在腹腔镜下施行回肠膀胱术。结果:3例手术均获成功,手术时间分别为320、280、270 min,出血量350、450、330 ml,淋巴结清扫数目为16、18、19枚,均为阴性,手术切缘阴性。术后3 d肠功能恢复,术后2周拔除单J管,无肠瘘尿瘘等并发症,术后住院时间8 d。术后随访分别为22、18、6个月,无复发及转移。结论:完全腹腔镜下根治性膀胱全切除回肠膀胱术进一步减少手术创伤,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 laparoscopic radical cystectomy ileal bladder surgery and to summarize the surgical techniques. Methods: Three cases of bladder cancer underwent laparoscopic radical cystectomy and laparoscopic ileal bladder surgery. Results: All three surgeries were successful. The operative time was 320, 280 and 270 min, the bleeding volume was 350, 450 and 330 ml, and the number of lymph node dissection was 16, 18 and 19, respectively. All were negative and the surgical margin was negative. The bowel function was recovered 3 days after operation, and the single J tube was removed 2 weeks after operation. No complications such as fistula of urinary fistula were found. The postoperative hospital stay was 8 days. Follow up were 22,18,6 months, no recurrence and metastasis. Conclusions: Total laparoscopic radical cystectomy of ileal bladder to further reduce the surgical trauma, anatomical structure revealed more satisfactory, is conducive to postoperative recovery. However, the surgery is more difficult, must be proficient in a variety of laparoscopic techniques before further development.