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目的:总结腹腔镜下膀胱癌根治加回肠膀胱术的手术方法及临床疗效。方法:2003年6月～2007年5月共行25例腹腔镜下根治性全膀胱切除、双侧盆腔淋巴结清扫加回肠膀胱术,患者平均年龄68岁,全膀胱切除和盆腔淋巴结清扫均在腹腔镜下完成,标本自下腹部小切口取出后,体外切取末端回肠10～15cm,近端闭合并与双侧输尿管吻合,远端造口于右下腹壁。结果:所有手术均顺利完成,手术时间210～320min,平均270min。术中出血220～1000ml,平均460ml。平均每例清扫淋巴结数10个,淋巴结阳性率16.2%,手术切缘均阴性。术后3～5天肠道功能恢复,1例因粘连性肠梗阻于术后1周再行手术探查松解粘连。术后2～3周拔除单J管,无肠漏及尿漏并发症发生。随访2～30个月,1例死于原发病转移,无腹壁造口狭窄发生,3例术后B超或造影显示单侧轻度肾积水和轻度输尿管扩张。结论:腹腔镜膀胱癌根治术具有创伤小,恢复快等优点,但手术难度较大,手术技术要求较高。回肠膀胱术手术操作相对简单,并发症少,可作为腹腔镜膀胱癌根治术后尿流改道可选方式之一。
Objective: To summarize the surgical methods and clinical effects of laparoscopic radical mastectomy plus ileal bladder surgery. Methods: From June 2003 to May 2007, 25 patients underwent laparoscopic radical cystectomy, bilateral pelvic lymph node dissection and ileal bladder surgery. The mean age was 68 years. All cystectomy and pelvic lymph node dissection were performed in the abdominal cavity After the microscope was completed, the specimen was removed from the small incision in the lower abdomen. The distal ileum was excised from 10 to 15 cm in vitro. The proximal end was closed and anastomosed with bilateral ureter. The distal stoma was placed on the right lower abdominal wall. Results: All the operations were successfully completed. The operation time ranged from 210 to 320 minutes with an average of 270 minutes. Intraoperative bleeding 220 ~ 1000ml, an average of 460ml. The average number of lymphadenectasis in each case was 10, the positive rate of lymph nodes was 16.2%. All the surgical margins were negative. The function of intestinal tract recovered 3 to 5 days after operation, and 1 case of adhesive intestinal obstruction was operated one week after operation to release the adhesions. After 2 to 3 weeks to remove a single J tube, no leakage of intestinal leakage and complications occurred. A follow-up of 2 to 30 months, 1 patient died of primary disease metastasis, no abdominal wall stenosis occurred, 3 cases of postoperative B-ultrasound or angiography showed mild hydronephrosis and mild ureteral dilatation. Conclusion: Laparoscopic radical mastectomy has the advantages of less trauma and faster recovery. However, the operation is difficult and the technical requirements for operation are high. Ileal bladder surgery is relatively simple, less complications, can be used as laparoscopic urinary tract diversion after radical surgery one of the options.