摘要
目的探讨腹腔镜下男性膀胱癌患者膀胱根治性切除术中减少出血量的解剖性操作体会。方法选取2016年5月至2018年10月间北京大学首钢医院、北京市门头沟区医院和山东省潍坊市人民医院收治的147例男性肌层浸润性膀胱尿路上皮癌患者,均采用腹腔镜膀胱根治性切除术,术中均行标准的盆腔淋巴结清扫术和膀胱前列腺切除,下腹正中小切口行开放手术回肠膀胱尿流改道。术后均未实施化疗和放疗。结果患者术中出血量190~450ml,平均238ml,均未输血。手术用时240~330min,平均293. 6min。147例患者均安全度过手术期。术后第1天盆腔引流平均100ml,第2天平均90ml,第3天平均30ml;盆腔引流管留置时间平均8. 3d。随访6~23个月,平均17. 7个月。147例患者无失访,147例患者均无瘤存活。结论腹腔镜下男性膀胱根治性切除术中,恰当使用操作器械和方法、沿寡血管间隙层面操作,尽早分离结扎膀胱前列腺动脉和静脉系统,能预防性控制出血,保持几乎无血的手术视野,减少失血。
Objective To summarize experiences of procedures to lessen blood loss in laparoscopic complete radical cystectomy in male patients with bladder cancer.Methods A total of 147 male patients with muscle-invasive urothelial carcinoma undergoing laparoscopic radical cystectomy from May 2016 to October 2018 were selected.Standard pelvic lymphadenectomy and laparoscopic complete radical cystectomy were performed in all the patients.Ileal conduit urinary diversions was performed through a midline incision of 6 to 8 cm below umbilicus.None of patients received any chemotherapy or radiotherapy postoperatively.Results Estimated total blood loss was 190 to 450 ml(average 238 ml).No blood transfusion was needed.Overall operation time was 240 to 330 min(average 293.6 min).All the patients safely get through the operation period.Pelvic drainage was 100,90 and 30 ml at 1,2 and 3 d after the operation,respectively.The average duration of pelvic drainage was 8.3 d.Patients were followed up for 6 to 23 months(average 17.7 months)and no drop-out occurred.All the patients survived free of tumors.Conclusion The satisfactory outcomes of lessening blood loss in laparoscopic radical cystectomy could be reached by means of properly using operative instruments and operations,operating within the spaces and planes among scant blood vessels,and ligating the arteries and veins in bladder and prostate as soon as possible.
作者
潘东亮
张录芳
廖代祥
高健
高兴
宋涛
刘鲁东
李宁忱
PAN Dong-liang;ZHANG Lu-fang;LIAO Dai-xiang;GAO Jian;GAO Xing;SONG Tao;LIU Ludong;LI Ning-chen(Department of Urology,Shougang Hospital,Peking University/Wu Jieping Urology Surgery Medical Center,Peking University,Beijing100144,China;Department of Urology,Weifang People's Hospital,Weifang261041,China;Department of Oncology,Beijing Mentougou District Hospital,Beijing102300,China;Department of Urology Surgery,Beijing Mentougou District Hospital,Beijing102300,China)
出处
《中国肿瘤临床与康复》
2019年第8期905-909,共5页
Chinese Journal of Clinical Oncology and Rehabilitation
