Matin Surena F, Gill Inderbir S
Section of Laparoscopic and Minimally Invasive Surgery, Urological Institute, The Cleveland Clinic, Ohio 44195, USA.
J Endourol. 2002 Aug;16(6):335-41; discussion 341. doi: 10.1089/089277902760261338.
Laparoscopic radical cystectomy with urinary diversion performed using intracorporeal techniques exclusively is a new development in the growing field of minimally invasive urology. This report details step by step the completely intracorporeal laparoscopic technique of cystectomy, bilateral pelvic lymphadenectomy, and urinary diversion with creation of an ileal conduit or neobladder, including the isolation of ileum, restoration of bowel continuity, retroperitoneal transfer of the left ureter to the right side, bilateral stented ureteroileal anastomoses, and urethroileal anastomosis in case of orthotopic diversion. Although at present, this is still a technique in development at high-volume medical centers, it holds promise as a minimally invasive yet appropriately radical form of treatment for patients with muscle-invasive bladder cancer. Definition of its true role awaits greater experience and long-term comparisons of the outcomes with those of traditional open surgery.
完全采用体内技术进行的腹腔镜根治性膀胱切除术及尿流改道术是微创泌尿外科这一不断发展领域中的一项新进展。本报告逐步详细介绍了完全体内腹腔镜下膀胱切除术、双侧盆腔淋巴结清扫术以及采用回肠导管或新膀胱进行尿流改道的技术，包括回肠游离、肠道连续性恢复、左输尿管向右侧的腹膜后转移、双侧输尿管支架置入的输尿管回肠吻合术，以及原位尿流改道时的尿道回肠吻合术。尽管目前这仍是一项在大型医疗中心尚在发展的技术，但它有望成为对肌层浸润性膀胱癌患者微创且适度根治的治疗方式。其真正作用的界定有待更多经验以及与传统开放手术结果的长期比较。
