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目的:探讨腹腔镜联合小切口全膀胱切除术+原位回肠代膀胱术可行性及治疗浸润性膀胱癌的效果。方法:先在腹腔镜下对10例浸润性膀胱癌患者行全膀胱切除术,并在下腹部行小切口体外建成W形回肠代膀胱储尿囊,再在腹腔镜下行原位回肠代膀胱与尿道吻合术,观察疗效。结果:所有手术均获成功,无中转开腹。10例手术,历时420-480min,平均456min,术中出血600-1 200ml,平均850ml。术中未发生直肠损伤,术后10例均有不同程度漏尿,9例1周后拔除盆腔引流管,1例3周漏尿停止拔除引流管,无1例盆腔内感染及肠瘘,病理诊断均为浸润性尿路上皮癌,其中1例盆腔淋巴结阳性。所有病例无漏尿及吻合口狭窄等并发症,术后3个月复查B超无肾积水表现,无慢性尿潴留表现。复查血生化指标无电解质紊乱。1例患者术后2个月出现持续腹胀,考虑为粘连性肠梗阻。其余病例术后随访1-3年,无肿瘤复发。结论:腹腔镜联合小切口全膀胱切除术+原位回肠代膀胱术具有创伤小、出血少、术后恢复快的优点,提高了患者生活质量,是治疗浸润性膀胱癌的一种理想方式,在基层医院开展亦有可行性。
Objective: To investigate the feasibility of laparoscopic combined with small incision cystectomy + ileal neobladder and the treatment of invasive bladder cancer. Methods: 10 cases of invasive bladder cancer under laparoscopic total cystectomy, and in the lower abdomen with a small incision in vitro into the W-shaped ileum on behalf of the bladder urinary bladder, and then in laparoscopic ileum on behalf of the bladder and urethra Anastomosis, observe the effect. Results: All surgeries were successful with no laparotomy. 10 cases of surgery, which lasted 420-480min, an average of 456min, intraoperative bleeding 600-1200ml, an average of 850ml. There was no rectal injury during operation. All patients had leakage of urine in 10 cases, 9 cases of pelvic drainage tube were removed after 1 week, and 1 case of leaking urine stopped drainage tube in 3 weeks. There was no pelvic infection and intestinal fistula in 1 case. Diagnosis is invasive urothelial carcinoma, of which 1 pelvic lymph node positive. All cases without leakage of urine and anastomotic stenosis and other complications, 3 months after the review of B-no hydronephrosis, no chronic urinary retention performance. Review of blood biochemical indicators without electrolyte imbalance. One patient developed persistent bloating 2 months after surgery, considered as adhesive ileus. The remaining cases were followed up for 1-3 years, no tumor recurrence. Conclusion: Laparoscopic combined with small incision cystectomy + ileal neobladder has the advantages of less trauma, less bleeding and quick recovery after operation, and improves the quality of life of patients. It is an ideal way to treat invasive bladder cancer, It is also feasible in primary hospitals.