Hong Sung-Hoo, Seo Seong-Il, Kim Joon Chul, Hwang Tae-Kon
Department of Urology, Kangnam St Mary's Hospital Seoul, Korea.
Int J Urol. 2005 Oct;12(10):869-74. doi: 10.1111/j.1442-2042.2005.01163.x.
We present our experience with the fi rst eight patients who underwent laparoscopic radical cystectomy with bilateral pelvic lymphadenectomy and extracorporeal urinary diversion. Patients, operative data and the surgical techniques are presented.
Between June 2003 and April 2004, seven men and one woman with organ-con fi ned muscle-invasive transitional cell carcinoma of the bladder underwent laparoscopic radical cystectomy with urinary diversion. The age range was 41-73 years. Laparoscopic radical cystectomy and bilateral pelvic lymphadenectomy were performed using fi ve ports by a transperitoneal approach. An ileal conduit diversion or ileal W-neobladder was constructed through the site of specimen retrieval.
We performed eight radical cystectomies with ileal conduits (six cases) or orthotopic ileal W-neobladders (two cases). Conversion to open surgery was necessary in one due to technical dif fi culty in urethroneobladder anastomosis. Mean operating time was 560 min (range 455-680). Mean estimated blood loss was 675 mL (range 400-1050). Two of the eight patients needed blood transfusion (800 mL each). Mean days to oral intake and ambulation was 4.4 (range 2-6) and 4.1 (range 3-5), respectively. Mean hospital stay was 12.8 days (range 7-28). Mean follow up was 6.1 months (range 4-14). Histopathological examination of the specimens revealed stage T2N0M0 in fi ve cases, T3aN0M0 in one, T3aN1M0 in one and T3bN1M0 in one. No metastases have been detected and all are alive and free of disease.
Laparoscopic radical cystectomy is feasible, although dif fi cult and technically demanding, and our results are promising. With more experience and improvement of the surgical technique, laparoscopic radical cystectomy with urinary diversion may become an alternative surgical method for treating the selected patients with localized muscle invasive bladder cancer.
我们介绍了前8例接受腹腔镜根治性膀胱切除术、双侧盆腔淋巴结清扫术及体外尿流改道术患者的经验。介绍了患者、手术数据及手术技术。
2003年6月至2004年4月，7例男性和1例女性患有器官局限性肌层浸润性膀胱移行细胞癌，接受了腹腔镜根治性膀胱切除术及尿流改道术。年龄范围为41 - 73岁。采用经腹腔途径通过5个端口进行腹腔镜根治性膀胱切除术和双侧盆腔淋巴结清扫术。通过标本取出部位构建回肠导管尿流改道术或回肠W形新膀胱。
我们进行了8例根治性膀胱切除术，其中6例行回肠导管术，2例行原位回肠W形新膀胱术。1例因尿道新膀胱吻合技术困难而转为开放手术。平均手术时间为560分钟（范围455 - 680分钟）。平均估计失血量为675毫升（范围400 - 1050毫升）。8例患者中有2例需要输血（各800毫升）。平均开始经口进食和下床活动时间分别为4.4天（范围2 - 6天）和4.1天（范围3 - 5天）。平均住院时间为12.8天（范围7 - 28天）。平均随访时间为6.1个月（范围4 - 14个月）。标本的组织病理学检查显示，5例为T2N0M0期，1例为T3aN0M0期，1例为T3aN1M0期，1例为T3bN1M0期。未检测到转移，所有患者均存活且无疾病。
腹腔镜根治性膀胱切除术可行，尽管困难且技术要求高，但我们的结果令人鼓舞。随着经验的增加和手术技术的改进，腹腔镜根治性膀胱切除术及尿流改道术可能成为治疗部分局限性肌层浸润性膀胱癌患者的替代手术方法。
