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目的:探讨完全腹腔镜下膀胱全切除及原位U形回肠新膀胱术的手术方法的细节优化及效果。方法:2014年10月~2016年2月,以随机分组的方式将46例临床诊断为局部进展性膀胱癌(cT2~3N0~2M0)的患者分为原有术式及改进术式组,接受完全腹腔镜下根治性膀胱切除及腔镜下直线切割闭合器形成原位U形回肠新膀胱术,对围手术期及随访资料进行收集。结果:46例完全腹腔镜下根治性膀胱切除以及尿路重建手术均获成功,A组手术时间253~376(273±37)min,术中出血量100~380(181±35)ml,术后住院时间17~28(22±4)d,术后肠功恢复时间1.8~4.1(2.8±0.4)d,术后进食流质时间为3.5(2.4~5.3)d;B组手术时间281±39(259~361)min,术中出血量110~360(172±23)ml,术后住院时间15~25(18±4)d,术后肠功恢复时间1.5~3.0(1.9±0.3)d,术后进食流质时间为2.4(1.9~4.8)d;两组均于术后第4~8天拔除腹腔引流管,术后2周拔除单J管和导尿管。结论:完全腹腔镜下膀胱根治性切除加直线切割闭合器原位U形回肠新膀胱术在经过术式的进一步优化后,保留了创伤小、出血少等优点,又在肠道功能恢复、术后并发症方面得到了更优异的结果,使得该术式进一步完善。
Objective: To investigate the complete optimization of laparoscopic total bladder resection and in-situ U-shaped ileal neo-bladder surgery. Methods: From October 2014 to February 2016, 46 patients with clinically diagnosed locally advanced bladder cancer (cT2 ~ 3N0 ~ 2M0) were randomly divided into two groups: the original operation group and the modified operation group, receiving Complete laparoscopic radical cystectomy and endoscopic linear incision closure device in situ U-shaped neo-bladder surgery, perioperative and follow-up data collection. Results: Totally 46 cases of radical laparoscopic radical cystectomy and urinary tract reconstruction were successful. The operative time was 253-376 (273 ± 37) min in group A, and the blood loss was 100-380 (181 ± 35) ml in group A The postoperative hospitalization time ranged from 17 to 28 days (22 ± 4) days, postoperative bowel function recovery time ranged from 1.8 to 4.1 (2.8 ± 0.4) days, postoperative food intake time ranged from 3.5 to 2.4 days (5.3 days) (259 ~ 361) min, blood loss within the range of 110 ~ 360 (172 ± 23) ml, postoperative hospital stay 15 ~ 25 (18 ± 4) d, postoperative intestinal function recovery time 1.5 ~ 3.0 , Postoperative feed fluid time was 2.4 (1.9 ~ 4.8) d; both groups were removed after 4 to 8 days after abdominal drainage tube, 2 weeks after removal of single J tube and catheter. Conclusions: The radical laparoscopic radical cystectomy plus linear incision closure in situ U-shaped neo-bladder surgery, after further optimization of surgical procedures, retains the advantages of less trauma and less bleeding, and in the gut function recovery, surgery Postoperative complications have been more excellent results, making the surgery further improved.