摘要
目的探讨腹腔镜下膀胱全切除——MainzⅡ式膀胱术的可行性。方法 2005年4月～2009年3月对6例浸润性膀胱癌行腹腔镜下膀胱全切除。下腹部置入5个trocar。先于腹腔镜下分离切除膀胱,并做盆腔淋巴结清扫。女性患者一并切除子宫、附件。再于直肠起始端对系膜缘切开直肠约10 cm,将标本经此开口从肛门取出,女性患者自阴道残端取出。于下腹正中做一15 cm纵切口。再取乙状结肠约10 cm,对系膜缘剖开,切口与直肠切口相连接,将所取直肠和乙状结肠从连接处对折双层缝合成贮尿囊后壁,左右输尿管分别与乙状结肠和直肠吻合,黏膜下潜行2～3 cm。双侧输尿管支架管由直肠引出体外,贮尿囊内放置F26三腔Foley 1根,最后双层缝合前壁建成Mainz贮尿囊。结果 6例腹腔镜下膀胱全切成功,手术时间500～660 min,平均540 min;出血量100～150 ml,平均120 ml。肛管保留7～10 d,双侧输尿管支架管保留14 d。6例随访3～24个月,平均12个月,1例术后有尿失禁,1个月后自行消失,另5例排尿正常;6例均无复发,均无上尿路梗阻及返流。结论腹腔镜下膀胱全切除——MainzⅡ式膀胱术技术简便可行,出血少,并发症少,效果良好,值得推广。
ObjectiveTo report the surgical techniques and results of laparoscopic radical cystectomy with the sigmoidorectal pouch（Mainz Pouch Ⅱ）.MethodsUnder general anesthesia,the operation was performed with five trocars with the patients at the supine position with the head 15 degrees lower.Under a laparoscope,the bladder was removed,and then pelvic lymphadenectomy was carried out.Female patients received hysterectomy and oophorectomy at the same time.Afterwards,a 10-cm incision was made on the proximal end of the rectum and the specimen was removed out of the anus through the incision（through the vaginal stump in female patients）.After the laparoscopy,a 15-cm incision was made on the midline at the lower abdomen,and a 10-cm segment of the sigmoid was isolated.The posterior wall of the sigmoid and rectum were anastomosed side-to-side,forming the posterior wall of the pouch.The mobilized ureters were drawn through the completed pouch plate and secured with sutures.They were then stented with F8 mono-pigtail ureteral catheters by way of the opened rectum.And a 3-cm submucosal tunnel was formed by suturing the mucosa over the ureters to accomplish an antireflux mechanism.The ureteral stents were led out through the rectum,and a F26 Foley catheter was placed transanally for pouch drainage.Finally the anterior wall of the pouch was closed.ResultsThe procedure was completed successfully in all of the cases within a mean of 540 min（500-600 min）.The intraoperative blood loss ranged from 100 to 150 ml with a mean of 120 ml.The rectal tube was removal on the 7-10th postoperative day and the ureteral stents were removed two weeks postoperatively.The patients were followed up for 3 to 24 months with a mean of 12 months,during which 1 patient developed urine incontinence,which was cured spontaneously in one month.No patient showed upper urinary occlusion or reflux.ConclusionLaparoscopic radical cystectomy with the sigmoidorectal pouch is feasible and effective for the treatment of bladder cancer with little blood loss,
出处
《中国微创外科杂志》
CSCD
2011年第4期322-324,共3页
Chinese Journal of Minimally Invasive Surgery
关键词
膀胱癌
腹腔镜
膀胱全切术
MainzⅡ式膀胱
Bladder neoplasm
Laparoscopy
Radical cystectomy
Sigmoidorectal pouch（Mainz Pouch Ⅱ）
