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目的 介绍腹腔镜下全膀胱切除的经验。 方法 浸润性膀胱癌患者 5例 ,男 4女 1,年龄 4 9～ 6 8岁 ,无远处转移。腹腔镜下行全膀胱切除术 ,前列腺切除或子宫次全切除。经腹壁造口取出切除物 ,行乙状结肠去带原位新膀胱术。 结果 5例手术成功 ,手术时间 2 10～ 2 70min ,开放原位新膀胱术时间 2 10～ 30 0min。腹腔镜手术中 ,以超声刀及双极电刀行膀胱侧韧带、前列腺血管蒂及前列腺尖部切断止血 ,未使用钛夹、结扎及Endo gal夹 ,术中及术后未见明显出血。腹腔镜下操作出血量 2 0 0ml,开放性原位新膀胱术出血量 4 0 0～ 80 0ml,输浓缩红细胞 0～ 4个单位。术后 4～ 5d恢复饮食 ,3周拔除输尿管支架管 ,4周拔除尿管。患者白天可完全控制排尿 ,2例夜间偶有尿失禁。术后病理证实 5例均为多发性浸润性膀胱癌 ,2～ 3级。肌层有不同程度浸润 ,膀胱外组织切缘及局部淋巴结未见肿瘤细胞浸润。 5例均未发生手术并发症。 结论 腹腔镜下膀胱根治切除术创伤小、出血少、恢复快 ,是全膀胱切除手术的一种很有前景的方法。
Objective To introduce the experience of laparoscopic total cystectomy. Methods 5 patients with invasive bladder cancer, 4 males and 1 females, aged 49 to 68 years old, without distant metastasis. Laparoscopic total cystectomy, prostatectomy or subtotal hysterectomy. The abdominal wall removed stoma incision, line sigmoid colon in situ neobladder surgery. Results The operation was successful in 5 cases, the operation time was 2 10 ~ 2 70min, and the time of open neobladder was 210 ~ 300min. During laparoscopic surgery, hemostatic ligaments, prostatic vascularization and prostatic apex were cut off with ultrasonic scalpel and bipolar electrosurgical tools. No titanium clips, ligation and Endo gal clips were used, and no obvious hemorrhage occurred during and after operation. Laparoscopic operation of blood loss 200ml, open-source neo-bladder bleeding 4000 ~ 80 0ml, transfusion of red blood cells 0 to 4 units. 4 ~ 5d after the resumption of diet, remove the ureteral stent 3 weeks, 4 weeks to remove the catheter. Patients during the day can completely control urination, urinary incontinence in two cases at night. Postoperative pathology confirmed five cases were multiple invasive bladder cancer, 2 to 3. Myometrium has varying degrees of infiltration, margins of extra-bladder tissue and local lymph nodes without tumor cell infiltration. None of the 5 patients had any surgical complications. Conclusions Laparoscopic radical cystectomy is a very promising method for total cystectomy because of less trauma, less bleeding and faster recovery.