腹腔镜根治性膀胱全切+原位回肠新膀胱术治疗浸润性膀胱癌

Laparoscopic radical cystectomy and orthotopic ileal neobladder used for treatment of invasive bladder cancer

摘要:

目的??探讨腹腔镜根治性膀胱全切+原位回肠新膀胱术的手术方法和经验。方法?回顾分析2011年3月-2014年10月该院14例浸润性膀胱癌患者的临床资料。结果?13例成功施行了腹腔镜根治性膀胱全切+原位回肠新膀胱术，1例因术中膀胱内肿瘤出血增加术野无法显露而中转开放手术。12例在直视下行新膀胱尿道间断吻合，2例在腹腔镜下采用单针连续缝合法行新膀胱尿道吻合。手术平均时间444 min，术中平均出血量490 ml。术后病理提示12例为膀胱尿路上皮癌，其中1例伴部分鳞状细胞癌，2例为膀胱腺癌。2例患者术后出现尿漏，经保守治疗后治愈，1例术后出现尿失禁。术后随访6～56个月，3例死于肿瘤远处转移，1例目前发生肿瘤颅内转移。其余10例目前仍无瘤生存，其中1例术后1年出现尿道内口狭窄，经行尿道狭窄内切开术后治愈。10例患者目前控尿功能恢复良好，新膀胱容量约300 ml。结论?腹腔镜根治性膀胱全切+原位回肠新膀胱术治疗膀胱癌疗效确切、安全、创伤小及术后恢复快，可作为临床浸润性膀胱癌的首选治疗方法。

Abstract:

Objective?To investigate the surgical methods and experience of laparoscopic radical cystectomy and orthotopic ileal neobladder for invasive bladder cancer.?Methods?The clinical data of 14 patients with invasive bladder cancer underwent laparoscopic radical cystectomy and orthotopic ileal neobladder were collected retrospectively during March 2011 and October 2014.?Results?The 13 patients with invasive bladder cancer were successfully completed laparoscopic radical cystectomy and orthotopic ileal neobladder. 1 case was treated with laparotomy because of unsatisfactory surgery field caused by excessive tumor bleeding. Twelve cases of the urethra-neobaldder anastomosis were completed through the abdominal incision, while for the other 2 cases, the anastomosis was done under the laparoscope, 2 cases were performed neovesicourethral anastomosis using single-needle running sutures through laparoscopy. The median operative time was 444 minutes, the mean intraoperative blood loss was 490 ml. Postoperative pathologic results confirmed that 12 cases were bladder transitional cell carcinoma (1 case with partial squamous cell carcinoma) and 2 cases with bladder adenocarcinoma. No severe complication occurred except for 2 cases of urinary leakage and 1 case of urinary incontinence. Patients were followed up for 6-56 months, within which 3 patients were died of distant metastasis, 1 case was detected with intracranial metastasis, 1 case was found with urethra-vesical anastomotic stenosis while cured after urethrotomy. Ten cases were well recovered and the mean volume of the neobladder was 300 ml.?Conclusions?Laparoscopic radical cystectomy and orthotopic ileal neobladder have the advantage of better therapeutic effects, safety, minimal invasion and rapid recovery, which are the preferred therapeutic methods for invasive bladder cancer.