论文部分内容阅读
目的探讨腹腔镜下根治性膀胱切除原位回肠新膀胱术的临床可行性,并总结手术技巧。方法对15例膀胱癌患者行腹腔镜下根治性膀胱切除术,并在腹腔镜下施行原位回肠新膀胱术。结果 15例手术时间为341±47.3(275~440)min,出血量740±336(300~1400)ml,术后病理证实均为膀胱尿路上皮癌,淋巴结清扫数目为16±4.4(10~27)枚,手术切缘均为阴性。术后3.8±0.9(3~6)d肠功能恢复,术后2周拔除单J管,1例出现吻合口肠瘘,其余无并发症发生,术后住院时间25±4.1(21~33)d。术后随访6~15个月,无复发或转移病例。结论完全腹腔镜下根治性膀胱切除及原位回肠新膀胱术进一步减少手术创伤,解剖结构显露较满意,有利于患者术后恢复。但由于手术难度较大,术者须熟练掌握各种腹腔镜操作技术后方可开展。
Objective To investigate the clinical feasibility of laparoscopic radical cystectomy in situ ileal neo-bladder surgery and to summarize the surgical techniques. Methods Fifteen patients with bladder cancer underwent laparoscopic radical cystectomy and laparoscopic ileal neo-bladder surgery. Results The operative time was 341 ± 47.3 (275 ~ 440) min and the bleeding amount was 740 ± 336 (300 ~ 1400) ml in 15 cases. All the pathological findings were bladder urothelial carcinoma with lymph node dissection number of 16 ± 4.4 (10 ~ 27) pieces, surgical margin were negative. The bowel function was recovered at 3.8 ± 0.9 (3-6) d postoperatively. Single J tube was removed 2 weeks after operation. Anastomotic fistula was found in 1 case and the rest without complications. The postoperative hospital stay was 25 ± 4.1 (21-33) d. All cases were followed up for 6-15 months without recurrence or metastasis. Conclusions The radical laparoscopic radical cystectomy and ileal neo-bladder surgery further reduce the surgical trauma and the anatomical structure is more satisfactory, which is in favor of postoperative recovery. However, due to the difficulty of surgery, surgeons must be proficient in various laparoscopic techniques before they can be carried out.