摘要
目的探讨完全腹腔镜根治性膀胱切除+ρ形原位回肠新膀胱术的疗效,并总结经验。方法回顾性分析2018年10月至2019年5月河北医科大学第二医院收治的11例膀胱癌患者的临床资料。均为男性;年龄33~77岁,平均64.4岁;体质指数18.0~31.8kg/m^2,平均23.2kg/m^2。既往行膀胱部分切除术1例,经尿道膀胱肿瘤切除术10例;病理诊断为浸润性尿路上皮癌10例,腺癌1例,均未行新辅助治疗。临床分期cT2a^3bN0~2M0。11例均行完全腹腔镜根治性膀胱切除+腔内构建ρ形原位回肠新膀胱术,具体方法为:切除膀胱后,距回盲瓣25cm处截取长约55cm的回肠段,近端保留15cm管腔作为输入袢,远端40cm回肠段以1∶1比例折叠,使用直线切割闭合器打通对折的肠段做成储尿囊,与输入袢一起形成"ρ"形,双侧输尿管与输入袢肠壁吻合,储尿囊远端与尿道吻合。记录手术时间、出血量、术后恢复情况、并发症等围术期数据及随访结果。结果本组11例均顺利完成手术,无中转开放病例。手术时间320~440min,平均357.1min。估计出血量100~300ml,平均207.1ml。处理肠管总时间80~100min,平均89.3min;其中储尿囊制作时间14~19min,平均16.1min。术后4h疼痛评分2~5分,平均3.8分;术后24h为1~4分,平均2.3分。术后排气时间2.5~3.5d,平均3.0d。术后21d拔除尿管,9例出现尿失禁,轻度6例,中度2例,中重度1例;9例日间使用尿垫0~3片,夜间使用尿垫1~3片;经盆腔锻炼4~18周后尿失禁逐渐消失。术后住院时间7~13d,平均10.4d。引流管拔除时间4~11d,平均6.7d。术后病理诊断:7例为高级别浸润性尿路上皮癌,3例为低级别浸润性尿路上皮癌,1例为腺癌。其中腺癌患者肿瘤侵及前列腺,淋巴结阳性,左侧(3/13),右侧(1/9);1例高级别浸润性尿路上皮癌淋巴结阳性,左侧(2/11),右侧(1/9),其余病例淋巴结均阴性;所有患者切缘阴性,病理分期pT2a^4aN0~2M0。9例术后采用吉西他滨+顺铂方案辅助化疗。1
Objective To explore the feasibility and advantages of totally laparoscopic radical cystectomy plus ρshape orthotopic ileal neobladder, and to summarize the experiences. Methods The clinical data of 11 patients with bladder cancer admitted to the second hospital of Hebei medical university from October 2018 to May 2019 were retrospectively analyzed. All patients were male, aged 33 to 77 years, with an average of 64.4 years. Body mass index ranged from 18.0 to 31.8 kg/m^2, with an average of 23.2 kg/m^2. One case underwent partial cystectomy and 10 cases underwent transurethral resection of bladder tumor, with 10 cases of invasive urothelial carcinoma and 1 case of adenocarcinoma. No case underwent neoadjuvant therapy, and all cases were clinically staged as cT2a-3bN0-2M0. Totally laparoscopic radical cystectomy and ρ shape orthotopic ileal neobladder intraperitonealy were performed. The specific procedures were described as follows. After bladder resection, the ileal segment of 55 cm in length was intercepted at 25 cm from ileocecal valve, with the proximal part retaining 15 cm lumen as the input loop, and the distal part of 40 cm ileum being folded in 1∶1 ratio. The folded intestinal segment was made into a allantoic sac by using a linear incision closure device, forming a "ρ" shape with the input loop, bilateral ureters and the input loop. Anastomosis of wall, distal end of allantoic and urethra was performed.Record the perioperative data such as operation time, estimated bleeding, postoperative recovery, complications, and follow-up results. Result All of the 11 cases underwent successfully operation, and no cases were transferred to open surgery. The operation time ranged from 320 to 440 minutes, with an average of 357.1 minutes. The estimated amount of bleeding ranged from 100 to 300 ml, with an average of 207.1 ml. The total time of intestinal tract procedure was 80-100 minutes, with an average of 89.3 minutes, and the time of allantoic preparation was 14-19 minutes, with an average of 16.1 minutes. Th
作者
汪鑫
朱猛
任立新
黎玮
王东彬
柳跃鹏
齐进春
张勇
Wang Xin;Zhu Meng;Ren Lixin;Li Wei;Wang Dongbin;Liu Yuepeng;Qi Jinchun;Zhang Yong(Department of Urology,The Second Hospital of Hebei Medical University,Shijiazhuang 050000,China)
出处
《中华泌尿外科杂志》
CAS
CSCD
北大核心
2019年第10期747-752,共6页
Chinese Journal of Urology
