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目的:对腹腔镜下根治性膀胱切除术手术步骤进行程序化设计,探讨其可行性、安全性及临床疗效。方法:将腹腔镜下根治性膀胱切除术程序化为5步,包括游离输尿管中下段、处理脐动脉及膀胱上动脉;分离膀胱、前列腺与直肠之间的间隙;分离膀胱侧壁、处理双侧侧韧带;分离膀胱前列腺前壁,结扎切断阴茎背深静脉复合体,切断尿道;盆腔淋巴结清扫等。采用上述程序化术式治疗69例膀胱癌患者,对患者的临床资料进行回顾性分析。结果:手术均在腹腔镜下完成,未中转开放手术。平均手术时间(136.0±20.4)min,平均出血量(203.0±61.7)ml,输血率7.2%。淋巴结清扫个数平均17.8个,阳性率28.9%。切缘阳性率4.3%。围手术期未发生严重并发症。平均随访11月,4例患者肿瘤出现远处转移,其中1例患者死亡。其他患者无肿瘤复发、转移。结论:将腹腔镜下根治性膀胱切除术程序化,可以缩短手术时间,减少手术并发症的发生,值得临床推广使用。
Objective: To design the procedure of laparoscopic radical cystectomy procedure and discuss its feasibility, safety and clinical efficacy. Methods: Laparoscopic radical cystectomy was programmed into 5 steps, including the free middle and lower ureter, the umbilical artery and the superior bladder artery, the separation of the bladder, the gap between the prostate and the rectum, the separation of the bladder sidewall, the bilateral Lateral ligament; Separation of the anterior wall of the bladder prostatic, ligation and amputation of the dorsal penile vein complex, cut off the urethra; pelvic lymph node dissection. Sixty-nine patients with bladder cancer were treated by the above procedures, and the clinical data of the patients were retrospectively analyzed. Results: All the operations were completed under laparoscopy and were not transferred to open surgery. The average operation time was (136.0 ± 20.4) min, the average bleeding volume was (203.0 ± 61.7) ml, the blood transfusion rate was 7.2%. The average number of lymph node dissection 17.8, the positive rate of 28.9%. Positive margins of 4.3%. Perioperative no serious complications. In a mean follow-up of 11 months, 4 patients had distant metastasis of the tumor, 1 of which died. Other patients without tumor recurrence, metastasis. Conclusion: The procedure of laparoscopic radical cystectomy can shorten the operation time and reduce the occurrence of operative complications, which is worthy of clinical application.