摘要
目的分析机器人膀胱根治性切除回盲肠原位新膀胱重建治疗肌层浸润性膀胱癌的疗效。方法2018年1月至2019年12月,我科对9例肌层浸润性膀胱癌患者行达芬奇机器人膀胱根治性切除术,并行原位回盲肠新膀胱重建术。手术方法:机器人膀胱全切并淋巴结清扫,对尿道残端进行4针预缝合,再于下腹部切口取回肠15 cm、回盲部及升结肠12 cm作为新膀胱,颈部与预缝合的尿道吻合形成原位新膀胱。结果手术均顺利完成,手术时间330~400 min,失血量400~800 mL。术后住院时间14~20 d。随访6~24个月,1例术后3个月出现吻合口狭窄,于膀胱镜下行尿道扩张后缓解,术后6个月复查尿路造影(CTU)均无上尿路积水,日间控尿满意。残余尿平均(50±10)mL,新膀胱容量平均为(400±50)mL,充盈期膀胱内压平均(18±2)cmH 2 O,逆行造影检查未见明显输尿管反流。结论肌层浸润性膀胱癌患者行机器人根治性膀胱切除后,在机器人辅助下预先缝合尿道,行开放式尿流改道术时既方便操作又缩短了手术时间。回盲肠原位新膀胱保留了肠道管状结构,不仅能低压储尿而且可依靠肠管的收缩力达到高压时克服尿道括约肌阻力从而排尿,尿控效果满意,逆行感染、尿失禁、残余尿等并发症发生较少,是一种值得推荐的尿流改道选择。
Objective To explore robot-assisted laparoscopic radical cystectomy(RALRC)and orthotopic ileocecal neobladder with a modified urethral reconstruction for the treatment of muscular invasive bladder cancer(MIBC).Methods RALRC plus orthotopic ileocecal neobladder was performed for 9 selected male MIBC patients during Jan.2018 and Dec.2019.After radical cystectomy and lymph node dissection,the urethral stump was pre-sutured with 4 stiches,then 15 cm ileum and 12 cm ileocecum and ascending colon were taken through a suprapubic incision to reconstruct a new bladder,and the cecal end of the new bladder was anastomosed to the urethra.Results All operations were successful.The operation time,estimated blood loss,postoperative hospital stay and follow-up were 330 to 400 minutes,400 to 800 mL,14 to 20 days and 6 to 24 months,respectively.Anastomotic stricture was observed in 1 case,which was relieved after urethral dilation was performed under cystoscope.Six months after operation,CTU showed satisfactory daytime urinary continence and no upper urinary hydrops.The mean residual urine volume was(50±10)mL,mean new bladder volume was(400±50)mL,and mean bladder pressure was(18±2)cmH 2O during the filling period.No obvious ureteral reflux was observed by retrograde angiography.Conclusions After MIBC is removed with RALRC,the urethra is pre-sutured with the aid of robot,which is convenient for operation and can shorten the operation time.The orthotopic ileocecal neobladder retains the intestinal tubular structure,which can not only store urine under low pressure but also overcome the resistance of urethral sphincter when the contractile force of the intestinal tube reaches high pressure to urinate,thus achieving satisfactory urinary control effect.There are fewer complications such as retrograde infection,urinary incontinence and residual urine.It is a recommended urinary diversion option.
作者
姜啸烨
高闫尧
孙振业
胡伟
王禾
付强
JIANG Xiao-ye;GAO Yan-yao;SUN Zhen-ye;HU wei;WANG He;FU Qiang(Department of Urology,Tangdu Hospital,Air Force Medical University,Xi an 710038,China)
出处
《现代泌尿外科杂志》
CAS
2020年第12期1099-1102,共4页
Journal of Modern Urology
基金
陕西省重点研发计划一般项目社会发展领域基金(No.2020SP-124)
唐都医院创新发展基金资助项目(No.2018LCYJ007)。
