完全腹腔镜下根治性膀胱全切除加回肠膀胱术(附10例报告)

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摘要目的:探讨全腹腔镜下根治性膀胱全切除加回肠膀胱术的手术方法和临床效果。方法:2012年1月~2012年9月对10例临床分期均低于T_4bN₀M₀的膀胱尿路上皮癌患者行全腹腔镜下根治性膀胱全切术加回肠膀胱术、扩大盆腔淋巴结清扫术。腹腔镜下制备回肠膀胱:距回盲部15 cm处取回肠段15 cm,Endo-GIA(6TB45, ETHICON)直线闭合切割器截取肠管,采用Endo-GIA上下齿闭合完成两端肠管侧侧吻合,再使用Endo-GIA闭合开放的肠管断端,恢复回肠肠管连续性。将左右侧输尿管断端分别与肠管吻合半周后,通过回肠置入单J管,继续完全吻合输尿管肠管。肠管与腹外斜肌腱膜间断缝合固定,远端与腹壁固定缝合作造瘘口。结果:全腹腔镜下根治性膀胱全切除加回肠膀胱术平均手术时间350(300~410)min,术中失血200~700 ml。所有切除肿瘤组织切缘病理检查为阴性,术后住院12~17 d。术后随访3~9个月,肾功能均正常,未见局部复发或转移。结论:根据初期的手术操作经验和随访结果,完全腹腔镜下膀胱癌根治性切除术加回肠膀胱术在临床上是可行和安全的。

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	陈光富
	张旭
	王希友
	马鑫
	许勇
	郭刚
	孙圣坤
	李宏召
	董隽

关键词 ：完全腹腔镜, 膀胱癌, 回肠膀胱术

Abstract：Objective:To investigate the clinical feasibility and safty of totally laparoscopic radical cystectomy with intracorporeal Ileal conduit urinary diversion and to summarize the operative technique.Methods:Between January 2012 and September 2012, 10 patients(7male and 3 female) underwent totally laparoscopic radical cystectomy with intracorporeal ileal conduit urinary diversion. Radical cystectomy in the female patient and radical cystoprostatectomy in the male patient were completed. Bilateral extended pelvic lymphadenectomy was done. A 15 cm. segment of ileum 15 cm. from the ileocecal junction was isolated, and ileo-ileal continuity was restored using Endo-GIA staplers (U.S.Surgical, Norwalk, Connecticut). An ileal bladder was constructed. Bilateral stented ureteroileal anastomoses were individually performed to the ileal bladder. All suturing was done exclusively using free-hand laparoscopic techniques and the entire procedure was completed intracorporeally.Results:The average operation time for laparoscopic radical cystectomy with intracorporeal ileal conduit urinary diversion was 350 min(300-410 min), with a blood loss ranging from 200 to 700 ml. Hospital stay was 12 to 17 days and surgical margins of the bladder specimen were negative in each case. Postoperative renal function was normal and excretory urography revealed unobstructed upper tracts. During followup ranging from 3 to 9 months 10 patients are doing well without local or systematic progression.Conclusions:Totally laparoscopic radical cystectomy with ileal conduit urinary diversion is technically feasible and safe and can be done intracorporeally without complications. However, its practical application requires improved long-term outcomes compared with open surgery.

Key words： totally laparoscopy bladder cancer ileal conduit urinary diversion

收稿日期: 2012-10-12

ZTFLH:

R737.14

通讯作者: 张旭, xzhang@foxmail.com

引用本文:

陈光富, 张旭, 王希友, 马鑫, 许勇, 郭刚, 孙圣坤, 李宏召, 董隽. 完全腹腔镜下根治性膀胱全切除加回肠膀胱术(附10例报告)[J]. 微创泌尿外科杂志, 2012, 1(1): 88-91.
Chen Guangfu, Zhang Xu, Wang Xiyou, Ma Xin, Xu Yong, Guo Gang, Sun Shengkun, Li Hongzhao, Dong Jun. Totally laparoscopic radical cystectomy with intracorporeal ileal conduit urinary diversion(Report of 10 cases). JOURNAL OF MINIMALLY INVASIVE UROLOGY, 2012, 1(1): 88-91.

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http://journal20.magtechjournal.com/Jwk_zgmnwk/CN/abstract/abstract976.shtml 或 http://journal20.magtechjournal.com/Jwk_zgmnwk/CN/Y2012/V1/I1/88

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