腹腔镜下经腹膜外入路膀胱癌根治术的初步体会

Initial experience of laparoscopic extraperitoneal approach for radical resection of bladder cancer

摘要:

目的 评估腹腔镜下经腹膜外入路膀胱癌根治术的可行性及临床疗效。方法 选取2017年5月－2019年5月肌层浸润性膀胱癌患者16例，年龄54～78岁，平均69.4岁。开展腹腔镜下腹膜外入路膀胱癌根治术，术中经腹膜外膀胱切除及淋巴清扫，3例行输尿管皮肤造口术，1例行Studer原位回肠新膀胱术，其余12例行Bricker回肠膀胱术，将回肠通道或回肠新膀胱置于腹膜外腔，完整关闭腹膜，观察术中术后并发症及术后肠道功能恢复情况。结果 所有患者均顺利完成手术，无1例中转开放手术或经腹腔入路手术，术中出血量120～360 mL，平均190 mL。3例输尿管皮肤造口患者术后第1天恢复饮食，其余13例术后平均4 d恢复饮食，住院时间7～19 d，平均13.8 d。随访8～32个月，未发现肿瘤复发及转移，无1例发生肠梗阻，1例出现轻度肾积水，随访无进行性加重，所有患者肾功能均正常。结论 腹腔镜下经腹膜外入路膀胱癌根治术具有良好的安全性及可行性，术后肠道功能恢复较快，值得临床推广。

Abstract:

Objective To evaluate the feasibility and clinical effect of laparoscopic radical resection of bladder cancer by extraperitoneal approach.Methods 16 cases of musculocutaneous invasive bladder cancer were selected from May 2017 to May 2019, aged 54 to 78 years, the average was 69.4 years old. Laparoscopic extraperitoneal approach for radical resection of bladder cancer was performed, extraperitoneal bladder resection and lymph node dissection was performed during operation, 3 cases underwent ureterocutaneostomy, 1 case underwent Studer orthotopic ileal neobladder, the remaining 12 cases underwent Bricker ileostomy, ileal channel or neobladder was put out of peritoneal cavity with complete closure of the peritoneum, complications and intestinal function recovery were observed after surgery.Results All the operations were completed successfully, no patients were converted to opening surgery or transperitoneal operation. Intraoperative blood loss was 120 ~ 360 mL, and the average was 190 mL. 3 cases of ureterocutaneostomy resumed diet on the first day after operation, and the other 13 cases resumed diet on average 4 days after operation, and the time of hospitalization after operation was 7 ~ 19 d, the average was 13.8 d. Follow up for 8 ~ 32 months showed no recurrence and metastasis, no intestinal obstruction occurred, 1 case had mild hydronephrosis and no progressive aggravation. All the patients had normal renal function.Conclusion Laparoscopic extraperitoneal radical cystectomy is safe and effective, and postoperative intestinal function recovery is faster, which is worthy of clinical promotion.