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目的:总结26例腹腔镜根治性膀胱切除、标准淋巴结清扫加尿流改道术的临床经验,评价此术式肿瘤学结果与功能性结果。方法:2005年8月～2011年5月对26例肌层浸润性膀胱肿瘤患者实施腹腔镜根治性膀胱切除、标准淋巴结清扫加原位膀胱重建术,包括13例T型原位回肠膀胱、11例Studer原位回肠膀胱与2例乙状结肠原位回肠膀胱,对手术时间、清扫淋巴结数量、围手术期并发症、术中出血量、输血量、上尿路形态与功能、术后原位膀胱控尿情况进行分析。结果:平均手术时间为6.24(4～8)h,平均出血量为397(100～800)ml,平均输血量为109(0～800)ml,平均清扫淋巴结数15(5～30)个,1例淋巴结阳性,无围手术期死亡。围手术期并发症发生率为16.7%(4/26),其中1例术后血肌酐上升至214.9μmol/L,6天后下降至正常范围;2例新膀胱尿道吻合口漏,经引流治愈;1例输尿管新膀胱吻合口漏行手术修补。随访19.9(1～67)个月,生存率为92.3%(24/26);1例鳞癌死于广泛转移,1例于术后55个月因急性心肌梗塞死亡。原位膀胱重建患者日间完全控尿率达88%(22/25);夜间完全控尿率60%(15/25),小于1块尿垫24%(8/25)。上尿路检查提示19.2%(5/26)术后45天内出现双侧肾盂及输尿管轻度暂时性扩张,其中2例有暂时性血肌酐升高,但均在3个月之内恢复到正常范围。结论:腹腔镜根治性膀胱切除、标准淋巴结清扫加下腹壁小切口行尿流改道术取得了满意的肿瘤学与功能性结果;其长期疗效需要进一步随访。
OBJECTIVE: To summarize the clinical experience of 26 cases of radical laparoscopic radical cystectomy, standard lymph node dissection and urinary diversion, and to evaluate the surgical results and functional outcome of this procedure. Methods: From August 2005 to May 2011, 26 cases of myasthenic invasive bladder tumor were treated by laparoscopic radical cystectomy, standard lymph node dissection and orthotopic bladder reconstruction, including 13 T-type ileal bladder, 11 Cases of Studer orthotopic ileal bladder and 2 cases of sigmoid colon ileum bladder, the operation time, the number of lymph nodes, perioperative complications, intraoperative blood loss, blood transfusion, upper urinary tract morphology and function, postoperative bladder control Urine situation analysis. Results The average operation time was 6.24 (4-8) h, mean blood loss was 397 (100-800) ml, average blood transfusion volume was 109 (0-800) ml, average number of lymph nodes was 15 (5-30) One patient had positive lymph nodes without perioperative death. The incidence of perioperative complications was 16.7% (4/26). One of the patients had postoperative serum creatinine increased to 214.9μmol / L and fell to the normal range after 6 days. Two cases had an anastomotic leakage of the bladder and urethra, which was cured by drainage. One case of urethral anastomotic leakage surgery repair. The survival rate was 92.3% (24/26) after 19.9 months (1-67 months) follow-up. One case of squamous cell carcinoma died of extensive metastasis and one case died of acute myocardial infarction 55 months after operation. During the day, the rate of complete control of urine during initial urinary bladder reconstruction was 88% (22/25). The rate of complete control of urine at night was 60% (15/25) and less than 1% (24/8). Upper urinary tract examination indicated that 19.2% (5/26) had mild temporary dilatation of bilateral pelvis and ureter within 45 days after surgery. Two of them had transient increase of serum creatinine, but returned to normal within 3 months range. Conclusions: The results of laparoscopic radical cystectomy, standard lymph node dissection plus small incision of the abdominal wall for urinary diversion achieved satisfactory oncology and functional outcomes; and its long-term efficacy needs further follow-up.