摘要
Background The laparoscopic radical cystectomy (LRC) with orthotopic ileal neobladder is now applied to treat invasive bladder cancer, however, it has not been well codified and illustrated We describe in this paper a technique step by step that we have developed in 33 patients and achieved excellent results Methods The surgical procedure can be divided into eight steps: laparoscopic pelvic lymphadenectomy and mobilization of the distal ureters; exposing Denonvillier’s space and the posterior aspect of prostate; exposing retropubic space and anterior surface of the bladder; dividing the lateral pedicles of the bladder and the prostate; dividing the apex of the prostate; extracorporeal formation of the ileal pouch; extracorporeal implantation of the ureters; and laparoscopic urethra neobladder anastomosis This operation was performed in 33 patients, 29 males and 4 females, with muscle invasive bladder cancer between December 2002 and September 2004 Results The operating time was 5 5-8 5 hours with an average of 6 5 hours; the estimated blood loss was 200-1000 ml with an average of 460 ml The surgical margins of the bladder specimen were negative in all patients There was no evidence of local recurrence at follow up of 1-21 months in all the patients However lymph node metastases were found in one case at 9 months postoperatively Most of patients achieved urine control 1 to 3 months after surgery The daytime continence rate was 94% (31 cases) and nighttime continence rate was 88% (29 cases) Urodynamic evaluation was performed between 3 and 6 months postoperatively for all cases The mean value of neobladder capacity was (296±37) ml The mean value of maximum flow rate was (18 7±7 1) ml/s The mean residual urine volume was (32±19) ml In all cases, excretory urography at 1 to 2 months postoperatively demonstrated slightly dilated upper urinary tracts without ureteral obstruction, which resolved at follow up Cystography showed neobladders being similar in shapes to normal T
Background The laparoscopic radical cystectomy (LRC) with orthotopic ileal neobladder is now applied to treat invasive bladder cancer, however, it has not been well codified and illustrated We describe in this paper a technique step by step that we have developed in 33 patients and achieved excellent results Methods The surgical procedure can be divided into eight steps: laparoscopic pelvic lymphadenectomy and mobilization of the distal ureters; exposing Denonvillier’s space and the posterior aspect of prostate; exposing retropubic space and anterior surface of the bladder; dividing the lateral pedicles of the bladder and the prostate; dividing the apex of the prostate; extracorporeal formation of the ileal pouch; extracorporeal implantation of the ureters; and laparoscopic urethra neobladder anastomosis This operation was performed in 33 patients, 29 males and 4 females, with muscle invasive bladder cancer between December 2002 and September 2004 Results The operating time was 5 5-8 5 hours with an average of 6 5 hours; the estimated blood loss was 200-1000 ml with an average of 460 ml The surgical margins of the bladder specimen were negative in all patients There was no evidence of local recurrence at follow up of 1-21 months in all the patients However lymph node metastases were found in one case at 9 months postoperatively Most of patients achieved urine control 1 to 3 months after surgery The daytime continence rate was 94% (31 cases) and nighttime continence rate was 88% (29 cases) Urodynamic evaluation was performed between 3 and 6 months postoperatively for all cases The mean value of neobladder capacity was (296±37) ml The mean value of maximum flow rate was (18 7±7 1) ml/s The mean residual urine volume was (32±19) ml In all cases, excretory urography at 1 to 2 months postoperatively demonstrated slightly dilated upper urinary tracts without ureteral obstruction, which resolved at follow up Cystography showed neobladders being similar in shapes to normal T
