Berglund Ryan K, Matin Surena F, Desai Mihir, Kaouk Jihad, Gill Inderbir S
Section of Laparoscopic and Minimally Invasive Surgery, Urological Institute, Cleveland Clinic Foundation, Cleveland, OH 44195, USA.
BJU Int. 2006 Jan;97(1):37-41. doi: 10.1111/j.1464-410X.2005.05897.x.
To present our experience with laparoscopic radical cystoprostatectomy and bilateral nephroureterectomy for organ-confined, muscle-invasive transitional cell carcinoma (TCC) of the bladder in two patients with dialysis-dependent end-stage renal disease (ESRD).
Two men aged 77 and 65 years with organ-confined, muscle-invasive TCC of the urinary bladder and pre-existing dialysis-dependent ESRD underwent laparoscopic bilateral pelvic lymphadenectomy, radical cystoprostatectomy and bilateral nephroureterectomy. Urine spillage was avoided and en bloc urothelial integrity between the bladder and the two renal specimens was maintained throughout the procedure. The intact, entrapped specimens were removed en bloc via a Pfannenstiel incision at the end of the procedure.
The total operative duration was 573 and 660 min, respectively, including repositioning and re-draping between each major step. Blood loss was 350 and 1000 mL, respectively. Both patients tolerated the procedure well and there were no intraoperative complications. The first patient resumed oral intake 3 days after surgery and was discharged home after 5 days. The second patient's course after surgery was complicated by a prolonged adynamic ileus and infection of the catheter placed for continuous ambulatory peritoneal dialysis. He was discharged 28 days after surgery and died from unknown causes at 30 days.
To our knowledge, this is the first report of radical urotheliectomy, consisting of bilateral pelvic lymph node dissection, radical cystoprostatectomy, and bilateral nephroureterectomy, using entirely intracorporeal laparoscopic techniques.
介绍我们对两名依赖透析的终末期肾病（ESRD）患者进行腹腔镜根治性膀胱前列腺切除术和双侧肾输尿管切除术治疗器官局限性、肌肉浸润性膀胱移行细胞癌（TCC）的经验。
两名分别为77岁和65岁的男性，患有器官局限性、肌肉浸润性膀胱TCC且已存在依赖透析的ESRD，接受了腹腔镜双侧盆腔淋巴结清扫术、根治性膀胱前列腺切除术和双侧肾输尿管切除术。术中避免了尿液外溢，整个手术过程中保持了膀胱与两个肾脏标本之间尿路上皮的完整性。手术结束时，通过耻骨上横切口将完整的、包裹好的标本整块取出。
总手术时长分别为573分钟和660分钟，包括每个主要步骤之间的重新定位和重新铺巾。失血量分别为350毫升和1000毫升。两名患者对手术耐受性良好，术中无并发症。第一名患者术后3天恢复经口进食，5天后出院回家。第二名患者术后病程出现了长时间的动力性肠梗阻以及用于持续非卧床腹膜透析的导管感染。他于术后28天出院，30天时死于不明原因。
据我们所知，这是首例使用完全腹腔镜体内技术进行根治性尿路上皮切除术的报告，该手术包括双侧盆腔淋巴结清扫、根治性膀胱前列腺切除术和双侧肾输尿管切除术。
