Türk I, Davis J W, Deger S, Winkelmann B, Schönberger B, Schellhammer P F, Loening S A
Klinik für Urologie, Universitätsklinikum Charité, Humboldt-Universität, Schumannstrasse 20/21, 10117 Berlin.
Urologe A. 2002 Mar;41(2):107-12. doi: 10.1007/s00120-002-0183-5.
Once laparoscopic radical prostatectomy has been mastered, the step to performing a radical cystectomy is not that far. The challenge is to create the urinary diversion by laparoscopy. In this report we describe our experience with 11 laparoscopic radical cystectomies and intracorporeal construction of a continent urinary diversion (Mainz pouch II) as a treatment option in patients with muscle-invading bladder cancer. All 11 procedures could be performed successfully. A conversion to open surgery was not required in any case. The mean surgery time was 6.7 h. Except for two pouch fistulas we did not observe any intra- or postoperative complications. The functional as well as the oncological results are convincing. Less morbidity and faster recovery are the main advantages of this minimally invasive procedure. In addition, the low levels of blood loss, fluid shifts, and electrolyte loss considerably reduce cardiovascular stress. Radical cystectomy and construction of a continent urinary diversion represent the limit of technically feasible laparoscopy and should be done exclusively in specialized centers.
一旦掌握了腹腔镜根治性前列腺切除术，开展根治性膀胱切除术也就不远了。挑战在于通过腹腔镜进行尿流改道。在本报告中，我们描述了11例腹腔镜根治性膀胱切除术及体内构建可控性尿流改道（迈因兹Ⅱ型贮尿囊）作为肌层浸润性膀胱癌患者治疗选择的经验。所有11例手术均成功完成。无一例需要转为开放手术。平均手术时间为6.7小时。除了两例贮尿囊瘘外，我们未观察到任何术中或术后并发症。功能及肿瘤学结果令人满意。发病率较低和恢复较快是这种微创手术的主要优点。此外，少量的失血、液体转移和电解质丢失大大减轻了心血管应激。根治性膀胱切除术及构建可控性尿流改道代表了腹腔镜技术可行的极限，应仅在专业中心进行。
