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目的总结我院应用腹腔镜下根治性膀胱切除及回肠原位新膀胱术的初步经验。方法采用腹腔镜下根治性膀胱切除与回肠原位新膀胱重建治疗浸润性膀胱癌患者8例。腹腔镜手术中以超声刀及双极电凝行膀胱侧韧带、前列腺血管蒂及前列腺尖部切断止血,经腹壁小切口取出切除物,行回肠去管成形新膀胱,然后在腹腔镜下将新膀胱与尿道吻合。结果 8例患者手术成功,手术时间5～7小时;术中出血量约200～650 ml,其中2例输血400 ml;术后3～4天恢复饮食,2周拔除输尿管支架管,3～4周拔除导尿管;患者白天可基本控制排尿,2例夜间有尿失禁,3月后基本恢复控尿;2例术后尿漏,经引流两周左右治愈。结论腹腔镜下全膀胱切除术及原位新膀胱术具有创伤小、出血少、恢复快、较好的新膀胱功能等优点;回肠新膀胱和尿道吻合具有操作方便、缝合紧密等优点,可积极推广。
Objective To summarize the preliminary experience of laparoscopic radical cystectomy and ileal neobladder in our hospital. Methods Eight cases of invasive bladder cancer were treated with laparoscopic radical cystectomy and ileal neobladder reconstruction. Laparoscopic surgery with ultrasonic scalpel and bipolar coagulation of the bladder side of the ligament, prostate peduncle and prostatic apex cut to stop bleeding through the abdominal small incision to remove the resection, the ileal tube to form a new bladder, and laparoscopic will be new Bladder and urethra anastomosis. Results The operation was successful in 8 patients and the operation time was 5 to 7 hours. The intraoperative blood loss was about 200-650 ml, of which 2 cases were transfused with 400 ml. The diet was resumed 3 to 4 days after operation and the ureteral stent was removed 2 to 3 weeks later. Week unplug the catheter; the patient can basically control urination during the day, 2 cases of urinary incontinence at night, 3 months after the basic resumption of urine control; 2 cases of postoperative urinary leakage, by drainage about two weeks to cure. Conclusions Laparoscopic total cystectomy and in-situ neobladder have the advantages of less trauma, less bleeding, faster recovery and better neo-bladder function. The anastomotic ileal neovaginal bladder and urethra have the advantages of convenient operation and close suture, which can be positive Promotion.