摘要
目的探讨三孔法腹腔镜膀胱根治性切除术治疗膀胱恶性肿瘤的有效性、安全性。方法2018年10月~2019年8月对19例膀胱癌行三孔法腹腔镜膀胱根治性切除术。打开盆腔腹膜,暴露外侧入路三层面;离断膀胱两侧血管蒂及输尿管;切除膀胱及附属器官;盆腔淋巴结清扫;盆腔腹膜重建;尿流改道:包括回肠新原位膀胱(全腹腔镜下操作)、回肠膀胱术、结肠膀胱术和输尿管皮肤造口等。结果19例成功完成三孔腹腔镜手术,均未输血,无中转开放及增加穿刺孔。平均手术时间203.5 min(138~287 min),平均出血量82.6 ml(50~200 ml),平均清扫淋巴结14.4枚(5~35枚),淋巴结阳性率2.6%(7/274)。尿流改道方式:12例回肠膀胱术(1例子宫切除术,1例左侧腹股沟斜疝修补术),1例双侧输尿管皮肤造口,1例结肠膀胱术,5例原位新膀胱(其中3例在全腹腔镜下完成)。术后病理分期:T1N0G33例,T2aN07例(1例合并前列腺导管内腺癌),T2bN04例,T2bN11例,T3aN01例,T4aN02例,T4aN12例;手术切缘阳性率为0。平均术后禁食水时间3.5 d(1~14 d)。术后住院时间7~23 d,平均13.8 d。术后近期并发症Clavien-Dindo分级Ⅰ级8例,Ⅱ级2例。中位随访时间6个月(1~11个月),患者均健在,局部复发1例(T4aN1),后续GC方案化疗2例(T4aN1和T4aN0各1例),治疗后均无远处转移。结论三孔法腹腔镜膀胱根治性切除术近期肿瘤根治效果良好,有利于简化手术。
Objective To evaluate the effectiveness and safety of three-port laparoscopic radical bladder resection in the treatment of bladder malignant tumors.Methods From October 2018 to August 2019,the three-port laparoscopic radical cystectomy was performed.We opened the pelvic peritoneum to expose the three layers of the lateral approach,cut off the vascular pedicles and ureters on both sides of the bladder,and remove the bladder and accessory organs.The pelvic lymph node dissection and pelvic peritoneum reconstruction were conducted.The urinary diversion included the ileal neo-in-situ bladder(under full laparoscopic surgery),ileal cystoplasty,Colonic cystoplasty and cutaneous ureterostomy.Results The three-port laparoscopic surgery was successfully completed in 19 cases,without blood transfusion,conversion to open surgery or additional puncture holes.The average operation time was 203.5 min(range,138-287 min),the average blood loss was 82.6 ml(range,50-200 ml),the average lymph node dissection was 14.4(range,5-35),and the positive rate of lymph nodes was 2.6%(7/274).Urinary diversion methods:12 cases of ileal cystoplasty(1 case of hysterectomy and 1 case of left inguinal hernia repair),1 case of bilateral cutaneous ureterostomy,1 case of colonic cystoplasty,5 cases of neo-in-situ bladder(3 cases were completed under full laparoscopy).Postoperative pathological staging:3 cases of T1N0G3,7 cases of T2aN0(1 case of prostate intraductal adenocarcinoma),4 cases of T2bN0,1 case of T2bN1,1 case of T3aN0,2 cases of T4aN0,2 cases of T4aN1.The positive rate of surgical margin was 0.The average postoperative fasting time was 3.5 days(range,1-14 days).The postoperative hospital stay was 7-23 days,with an average of 13.8 days.The recent postoperative complications were classified by Clavien-Dindo in 8 cases of gradeⅠand 2 cases of gradeⅡ.The median follow-up time was 6 months(range,1-11 months).All the patients were alive.One case had local recurrence(T4aN1),and 2 cases were followed by GC chemotherapy(each for T4aN1 and T4aN0
作者
张多兵
彭龙飞
何可
曹张军
王琦
杨超
于德新
毕良宽
Zhang Duobing;Peng Longfei;He Ke(Department of Urology, Second Affiliated Hospital of Anhui Medical University, Hefei 230601, China)
出处
《中国微创外科杂志》
CSCD
北大核心
2021年第2期169-174,共6页
Chinese Journal of Minimally Invasive Surgery
基金
国家自然科学基金面上项目(81572107)
安徽医科大学第二附属医院临床研究培育计划项目(2020LCZD03)。
关键词
三孔法
腹腔镜
膀胱癌
膀胱根治性切除术
盆腔淋巴结清扫
尿流改道
Three-port method
Laparoscopy
Bladder cancer
Radical bladder resection
Pelvic lymph node dissection
Urinary diversion
