摘要目的:介绍一种改良的手术方法——膀胱镜引导下经耻骨上气膀胱膀胱肿瘤切除术(CRBTSP),用以治疗电切镜不能插入膀胱行电切操作膀胱癌患者。方法:1例膀胱癌患者因F26、F24电切镜均难以通过尿道,取F19硬性膀胱镜插入膀胱,取5 mm Trocar自耻骨上2横指处穿刺置入膀胱。建立CO2气膀胱,自Trocar插入腹腔镜单极电凝钩,在膀胱镜直视下行膀胱肿瘤切除术。记录手术时间,出血量,肾功电解质,术后住院时间,并发症,拔管时间、切口愈合情况。结果:手术过程顺利,肿瘤切除过程大约10 min,基本无出血。术后肾功电解质正常,尿管留置时间为5天,拔管后患者排尿良好。病理报告示低级别乳头状尿路上皮癌。术后无明显并发症出现,切口愈合良好。住院时间5天,定期灌注,随访3个月,肿瘤无复发。结论:CRBTSP技术上可行,这种方法可应用于电切镜不能插入膀胱的膀胱肿瘤患者。
Abstract：Objective:To introduce a modified method, cystoscope-guided resection of bladder tumor through suprapubic route within pneumovesicum(CRBTSP), for treating one patient suffering from bladder tumor with urethral stricture. Methods:A patient, diagnosed as bladder tumor,with difficulty inserting Resectoscope(F26 and F24)through urethral, underwent CRBTSP, applying a one-port(5 mm trocar). A 5-mm trocar was placed into the bladder through the skin 2 cm above the pubic bone. After bladder was drained away,pneumovesicum was established with carbon dioxide (CO2) insufflation. Then the tumor was resected by a monopolar +hook through the trocar and repetitious irrigating was performed with distilled water. After that,the urethral catheter was inserted. The operative time, blood losses,postoperative hospital staying, complications and the time of convalescence were recorded. Results:The procedures were technically successful transvesically with no need for additional ports or conversion to standard open operation. The tumor was about 1 cm×1 cm×1 cm. The operative duration for the resection procedure was about 10 min. Blood loss was 5 mL and cathederization duration was 7 d. The patient regained continence well after cathederization. There were no positive margins. No complication occurred. The patient was followed up 3 months later with no recurrence. Conclusions:CRBTSP is technically feasible. This noval approach is available for patients suffering from bladder tumor with urethral stricture.
