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目的:探讨腹腔镜下根治性全膀胱切除术的手术方法和临床体会。方法:我院于2008年7月～2010年12月对10例经病理证实为浸润性膀胱移行细胞癌患者行腹腔镜下根治性全膀胱切除术。其中男9例,女1例,年龄64～80岁,平均69岁。其中5例行原位回肠代膀胱术,5例行输尿管皮肤造口术,观察手术用时、术中出血量、术后肠道功能恢复时间、并发症及手术疗效。结果:手术用时170～290min,平均210min;术中出血150～950ml,平均250ml;术后肠道功能恢复约72h;术后未发生肠瘘及吻合口狭窄及尿瘘等严重并发症,无围手术期死亡,术后3个月IVU未见肾积水。结论:经腹腹腔镜全膀胱切除术安全可行,能明显减少手术创伤,术中出血少,术后恢复快、并发症少,随着器械的改进及技术熟练,该术式将成为全膀胱切除手术的一种很有前景的方法。
Objective: To investigate the surgical method and clinical experience of laparoscopic radical cystectomy. Methods: From July 2008 to December 2010, 10 patients with invasive bladder transitional cell carcinoma confirmed pathologically underwent laparoscopic radical cystectomy. Including 9 males and 1 female, aged 64 to 80 years, mean 69 years. Among them, 5 patients underwent ileal neobladder and 5 patients underwent ureteral skin ostomy. The operation time, intraoperative blood loss, postoperative intestinal function recovery time, complications and operative efficacy were observed. Results: The operation time ranged from 170 to 290 minutes, with an average of 210 minutes. The intraoperative bleeding ranged from 150 to 950ml with an average of 250ml. The postoperative recovery of intestinal function was about 72 hours. No serious complications such as intestinal fistula and anastomotic stricture and urinary fistula occurred after operation. Period of death, IVU no hydronephrosis after 3 months. Conclusions: Laparoscopic total cystectomy is safe and feasible, which can significantly reduce the surgical trauma, less bleeding during operation, quick recovery after operation and less complications. With the improvement of the instruments and skill, the procedure will be a total cystectomy A promising method of surgery.