摘要
目的探讨完全腔镜下根治性膀胱切除术及体内原位新膀胱重建术的围手术期和肿瘤学结果。方法回顾性分析2010年3月至2019年12月浙江省人民医院行腹腔镜根治性膀胱切除术(LRC)或机器人辅助腹腔镜根治性膀胱切除术(RARC)加体内原位新膀胱重建术的218例膀胱癌患者的临床资料。男166例,女52例;中位年龄62(52,70)岁,美国麻醉医师协会评分1~2分183例,3分35例;吸烟史80例,腹部手术史33例,高血压病61例,糖尿病28例,心脏病26例;3例接受新辅助化疗。82例行LRC,136例行RARC。手术采用从右至左先清扫盆腔淋巴结再行膀胱前列腺切除的方式。保留输尿管周围血供及周围腹膜,采取筋膜内方式切除前列腺,取30 cm回肠末段利用切割闭合器制成U形新膀胱,然后在无张力条件下吻合尿道残端与两侧输尿管,术中使用单J管作为输尿管支架与导尿管一起引出体外。评估围手术期结果。采用Kaplan-Meier法进行生存分析。结果218例手术均顺利完成,无中转开放手术。总体手术时间为281(229,400)ml,术中出血量为200(100,480)ml,术中输血24例,住院时间15(13,22)d,11例(5.0%)术中出现并发症,术后排气时间2(1,3)d,进固体食物时间4(3,5)d。术后30 d内总并发症为61例(28.0%),术后30~90 d总并发症为81例(37.2%)。所有患者中位淋巴结清扫数量为19(14,24)枚,淋巴结阳性21例(9.6%),切缘阳性6例(2.7%)。术后肿瘤病理分期Ta/T1/Tis期48例,T2期134例,T3期36例。218例中位随访时间33.0(20.6,48.2)个月,77例肿瘤复发,55例死亡,其中39例为肿瘤特异性死亡。生存分析结果显示,所有患者的5年无病生存率、总生存率、肿瘤特异性生存率分别为55.4%、62.4%、66.4%。结论完全腔镜下根治性膀胱切除术及体内原位新膀胱重建术能很好地应用于肌层浸润性或高危非肌层浸润性膀胱癌的治疗,腔镜下完全体内重建膀胱切实可行,术后肠道及新膀胱并发症少,术后恢
Objective To investigate the perioperative and oncological outcomes in patients undergoing laparoscopic radical cystectomy with intracorporealorthotopic neobladder reconstruction.Methods Clinical data of bladder cancer patients undergoing laparoscopic radical cystectomy(LRC)or robot-assisted radical cystectomy(RARC)with intracorporealorthotopic neobladder reconstruction in Zhejiang Provincial People's Hospital from March 2010 to December 2019 were retrospectively analyzed.There were 166 males and 52 females.The median age was 62(52,70)years old.The ASA score was 1-2 in 183 cases(83.9%)and 3 in 35 cases(16.1%).There were 61 cases of hypertension,28 cases of diabetes,26 cases of heart disease,33 cases of history of abdominal surgery,and 3 cases received neoadjuvant chemotherapy.LRC was performed in 82 cases and RARC in 136 cases.The operation was performed by dissecting pelvic lymph nodes from right to left and then cystoprostatectomy.The periureteral blood supply and periperitoneal peritoneum were preserved,and the prostate was resected by intrafascial resection.The 30 cm terminal ileum was used to make a U-shaped new bladder,and then the urethral stump and both sides of the ureter were anastomosed on new bladder without tension.During the operation,two single J tubes were used as ureteral stent.The perioperative and pathological results results were evaluated.Results The operations of 218 patients were completed successfully and there was no conversion to open operation.The median operation time was 281(229,400)ml.Intraoperative blood transfusion was performed in 24 cases(11.0%).Hospital stay was 15(13,22)days.Intraoperative complications happened in 11 cases(5.0%).Exhaust time was 2(1,3)days.Solid food intake time was 4(3,5)days.Total complications within 30 days after operation were 61 cases(28.0%),and total complications within 30-90 days after operation were 81 cases(37.2%).The number of median lymph node dissection in all patients was 19(14,24).Positive lymph nodes in 21 cases(9.6%).Positive margin in 6 case
作者
王帅
祁小龙
刘锋
张琦
毛祖杰
张朴
张大宏
Wang Shuai;Qi Xiaolong;Liu Feng;Zhang Qi;Mao Zujie;Zhang Pu;Zhang Dahong(Department of Urology,Zhejiang Provincial People Hospital,People Hospital Affiliated to Hangzhou Medical College,Hangzhou 310004,China)
出处
《中华泌尿外科杂志》
CAS
CSCD
北大核心
2020年第11期830-834,共5页
Chinese Journal of Urology
基金
浙江省中医药科技计划项目(2017ZA009)
浙江省医药卫生科技项目(2018KY263)。
关键词
膀胱肿瘤
癌
腹腔镜手术
根治性膀胱切除术
尿流改道
Urinary bladder neoplasms
Carcinoma
Laparoscopic surgery
Radical cystectomy
Urinary diversion
