摘要
目的探讨三孔法完全腹腔镜Studer原位新膀胱术的安全性及疗效。方法2019年3月~2020年10月,对30例男性膀胱癌行三孔法腹腔镜膀胱根治性切除淋巴结清扫术,均保留血管神经束,关闭侧腹膜后,采用三孔法完全腹腔镜Studer原位新膀胱术完成尿流改道。结果手术顺利完成,手术时间(284.1±32.4)min,中位估计失血量100(55~300)ml,中位术后住院时间15(8~22)d。中位淋巴结清扫数目22(11~37)枚,淋巴结阳性1例。pT1N0期10例,pT2aN0期8例,pT2bN0期5例,pT3aN0期6例,pT3aN1期1例。住院期间并发症14例,Clavien-Dindo分级Ⅰ级10例,Ⅱ级4例。中位随访时间13(3~22)个月,无死亡。术后3个月评估,新膀胱容量(305±63)ml。28例日间自主排尿满意,17例夜间需要定时排尿1~2次。22例随访时间满1年,术后12个月中位国际勃起功能问卷5(IIEF-5)评分14.5(7~23)分。1例因双肾严重积水行输尿管新膀胱再植,1例肿瘤局部复发。结论三孔法完全腹腔镜Studer原位新膀胱术治疗膀胱癌安全可靠,在肿瘤根治、新膀胱容量、男性尿控和性功能恢复等方面效果较满意。
Objective To explore the safety and efficacy of three-port laparoscopic intracorporeal Studer orthotopic neobladder(TLISON).Methods From March 2019 to October 2020,thirty male patients with bladder cancer underwent three-port laparoscopic radical cystectomy and lymph node dissection.During the operation,the vascular nerve bundle was preserved,and after closing the lateral peritoneum,the urinary diversion was completed by TLISON.Results The operation was successfully completed.The operation time was(284.1±32.4)min,the estimated median blood loss was 100 ml(range,55-300 ml),and the median postoperative hospital stay was 15 d(range,8-22 d).The median number of lymph nodes cleared was 22(range,11-37),with 1 case of positive lymph node.Postoperative pathology showed 10 cases of pT1N0,8 cases of pT2aN0,5 cases of pT2bN0,6 cases of pT3aN0 and 1 case of pT3aN1.In-hospital complications occurred in 14 cases.The Clavien-Dindo classification showed 10 cases in GradeⅠand 4 cases in GradeⅡ.The median follow-up time was 13 months(range,3-22 months),and there was no death.The volume of the new bladder was(305±63)ml evaluated at 3 months postoperatively.There were 28 cases of satisfied with spontaneous urination in daytime,and 17 cases needing to urinate regularly once or twice at night.A total of 22 cases were followed up for one year,and the median International Index of Erectile Function Questionnaire 5(IIEF-5)score was 14.5(range,7-23)at 12 months after operation.One case underwent ureter neobladder replantation due to severe hydronephrosis,and one case had local tumor recurrence.Conclusions TLISON operation is safe and reliable in the treatment of bladder cancer.It has satisfactory results in radical resection of tumor,new bladder volume,male urinary control and sexual function recovery.
作者
庹舟廷
张映
刘昆
汪鑫
王进有
毕良宽
Tuo Zhouting;Zhang Ying;Liu Kun(Department of Urology, Second Hospital of Anhui Medical University, Hefei 230601, China)
出处
《中国微创外科杂志》
CSCD
北大核心
2022年第5期375-380,共6页
Chinese Journal of Minimally Invasive Surgery
基金
国家自然科学基金面上项目(81572107)
安徽省自然科学基金面上项目(2108085MH297)
安徽医科大学校科研基金(2021xkj164)
安徽医科大学第二附属医院临床研究培育计划项目(2020LCZD03,2021LCZD04)。
