摘要
目的探讨腹腔镜下保留神经膀胱全切联合抗反流新膀胱重建术的应用价值。方法回顾性分析2016年1月~2019年6月39例膀胱癌行腹腔镜下保留神经的根治性膀胱全切+输尿管与储尿囊抗反流回肠新膀胱构建的资料。男37例,女2例,平均年龄59(47~70)岁。采用前列腺筋膜内切除技术(女性保留卵巢、子宫等生殖器官)行膀胱全切,回肠壁瓣联合输尿管拖入吻合抗反流新膀胱构建。随访6个月以上。结果手术均顺利完成。平均手术时间306(260~470)min,其中抗反流新膀胱构建时间43(35~55)min。估计失血量253(150~800)ml。术后平均随访22.5(6~43)月,1例术后33个月肿瘤相关死亡。术后30天内并发症10例(26%),术后30天后并发症3例(8%),均为Clavien-Dindo 1~2级,无膀胱输尿管反流和吻合口狭窄。完全控尿率术后1、6、12个月日间分别为72%(28/39)、97%(38/39)和100%(38/38),夜间分别为54%(21/39)、72%(28/39)和84%(32/38)。37例男性患者术前国际勃起功能指数5(International Index of Erectile Function 5,IIEF-5)得分均≥15,术后6、12个月勃起功能恢复正常(IIEF-5得分≥15)占比分别为46%(17/37)和57%(21/37)。结论腹腔镜下保留神经的根治性膀胱切除+抗反流新膀胱术安全、有效,无严重并发症,短期肿瘤学结果和功能恢复较满意。
Objective To evaluate the clinical value of the nerve-sparing laparoscopic radical cystectomy with antireflux neobadder reconstruction.Methods Clinical data were retrospectively analyzed on 39 patients with bladder cancer who underwent nerve-sparing laparoscopic radical cystectomy with ureter and allantoic antireflux ileal neobladder reconstruction from January 2016 to June 2019.There were 37 males and 2 females,with an average of 59(range,47-70)years old.We conducted the nerve sparing with intrafascial laparoscopic radical cystectomy(for women,reproductive organs such as ovaries and uterus were retained)and the orthotopic ileal neobadder with the ileum valvuloplasty and pulling antireflux technique for ureter-neobadder anastomosis.Follow-ups lasted for more than 6 months.Results All the operations were successfully completed.The mean operative time were 306(range,260-470)min,and the time for neobladder reconstruction was 43(range,35-55)min.The average intraoperative blood loss were 253(range,150-800)ml.Follow-up time was 22.5(range,6-43)months.There was 1 case of cancer related death at 33 months after surgery.The complication rates were 26%(10/39)within 30 days after the operation and 8%(3/39)after 30 days.All of the complications were Clavien-Dindo grade 1-2.Stricture of the ureteral-neobladder anastomisis was not recorded.The continence rates at 1,6 and 12 months postoperatively were 72%(28/39),97%(38/39),and 100%(38/38)in daytime,and 54%(21/39),72%(28/39),and 84%(32/38)in nighttime,respectively.The International Index of Erectile Function 5(IIEF-5)score in 37 male patients before operation was more than 15.The proportion of IIEF-5>15 at 6 and 12 months after operation was 46%(17/37)and 57%(21/37),respectively.Conclusions Nerve-sparing laparoscopic radical cystectomy with antireflux neobadder reconstruction is feasible and safe,without serious complications.The short-term oncology results and functional recovery are satisfactory.
作者
朱再生
王跃平
童建勇
陈良佑
刘全启
罗荣利
徐礼臻
周鹏飞
朱子巍
Zhu Zaisheng;Wang Yueping;Tong Jianyong(Department of Urology, Jinhua Hospital Affiliated to Zhejiang University School of Medicine, Jinhua 321000, China)
出处
《中国微创外科杂志》
CSCD
北大核心
2021年第10期879-883,共5页
Chinese Journal of Minimally Invasive Surgery
基金
浙江省基础公益研究计划项目(LGF18H050006)
浙江省金华市(社发类)科技重点研究项目(2016-3-004)。
