Abstract：Objective: To evaluate the clinical efficacy and application value of modified four-hole laparoscopic radical cystectomy and bricker operation. Methods: Between January 2014 and June 2015, 31 patients (26 males and 5 females) underwent modified four-hole laparoscopic radical cystectomy and bricker operation by the same surgeon. The mean age was 63.7 years (47-78 years). Laparoscopic radical cystectomy and bilateral pelvic lymphadenectomy were performed (uterus, bilateral ovaries and part of anterior vagina wall in females) with traditional four-hole method. The specimen and marked intestine were taken out from the expanded working canal on the right exterior of rectus abdominis (vagina in females). The ileal conduit was then completed. Results: All operations were performed successfully. There was no conversion to open surgery. The mean surgical duration was 307.7 min (240-420 min). The mean estimated blood loss was 243.5 mL (100-500 mL). Two cases were given transfusion of 650 and 680 mL during operation, due to slight anemia, respectively. All surgical margins were negative. All patients engaged in activities 2-4 days postoperatively. The anal exhaust time was 4-7 days postoperatively. There was no urinary, intestinal fistula and other severe complications. Two patients who suffered incomplete intestinal obstruction were cured after conservative treatment. One patient who suffered slight bilateral hydronephrosis due to urinary infection after removal of the single J stent recovered after the conservative treatment. Conclusions: The modified four-hole laparoscopic radical cystectomy and bricker operation is a better improvement based on the traditional four-hole method. It is worth applying and recommending with shorter incision, more cosmetic and quicker recovery.
[1] 那彦群,叶章群,孙光,等.中国泌尿外科疾病诊断治疗指南.北京:人民卫生出版社,2011:17. [2]Haber GP, Crouzet S, Gill IS. Laparoscopic and robotic assisted radical cystectomy for bladder cancer: a critical analysis. Eur Urol, 2008;54(1):54-62. [3]Chade DC, Laudone VP, Bochner BH, et al. Oncological outcomes after radical cystectomy for bladder cancer: open versus minimally invasive approaches. J Urol, 2010,183(3): 862-869. [4]Nieuwenhuijzen JA, de Vries RR, Bex A, et al. Urinary diversions after cystectomy: the association of clinical factors, complications and functional results of four different diversions. Eur Urol, 2008,53(4): 834-844. [5]Gill IS, Fergany A, Klein EA, et al. Laparoscopic radical cystoprostatectomy with ileal conduit performed completely intracorporeally: the initial 2 cases. Urology, 2000,56(1):26-30. [6]王勤章,欧阳松.腹腔镜根治性膀胱切除和尿流改道术的应用现状.临床外科杂志,2014,22(2):87-90. [7]黄健,刘皓,林天歆,等.腹腔镜下根治性膀胱切除术现状及展望:十年经验总结及文献系统分析. 中华泌尿外科杂志,2012,33(11):805-809. [8]Beecken WD, Wolfram M, Engl T, et al. Robotic-assisted laparoscopic radical cystectomy and intra-abdominal formation of an orthotopic ileal neobladder. Eur Urol, 2003,44(3): 337-339. [9]刘锋,王帅,祁小龙,等.完全腹腔镜下根治性膀胱切除及原位U形回肠新膀胱术19例报告.中华泌尿外科杂志, 2015,36(4):270-275.
