Lin Tian-xin, Zhang Cai-xia, Xu Ke-wei, Huang Hai, Jiang Chun, Han Jin-li, Yao You-sheng, Guo Zheng-hui, Xie Wen-lian, Yin Xin-bao, Huang Jian
Department of Urology, Second Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong 510120, China.
Chin Med J (Engl). 2008 May 20;121(10):923-6.
Bladder carcinoma is the most common malignant urological tumor in China. We present our preliminary experience and results of laparoscopic radical cystectomy (LRC) with orthotopic ileal neobladder in female patients with bladder carcinoma.
From February 2003 to February 2008, 14 female patients with bladder carcinoma underwent LRC with orthotopic ileal neobladder. Nine of these patients underwent hysterectomy and ovariectomy, and the other 5 had preservation of the uterus and ovarian appendage. Standard bilateral pelvic lymphadenectomy was followed by radical cystectomy that was completed laparoscopically with hysterectomy and ovariectomy when needed. The tumor was removed by a 4 - 5 cm lower midline abdominal incision, followed by the construction of ileal neobladder and the extracorporeal anastomosis of ureter-neobladder. The neobladder was anastomosed to the urethral stump under a laparoscope.
The mean operative time and blood loss in the 14 patients were 350.2 minutes and 349.8 ml, respectively. Postoperative complications included uretero-pouch anastomotic stricture in 1 patient and pouch-vaginal fistula in 1 patient. Follow-up time of all patients ranged from 3 to 60 months, and 12 patients were followed up for more than 6 months and achieved micturition in half a year. One patient had occasional day-time urinary incontinence and 2 had night-time incontinence. Two patients who had undergone hysterectomy and ovariectomy had voiding difficulties after one year, which was treated by intermittent self-catheterization. The mean volume of the neobladder and the residual urine were 333.6 ml and 31.2 ml, respectively. Surgical margins were tumor free for all patients. One patient had bone metastasis and died 11 months after the operation.
LRC with orthotopic ileal neobladder in female patients is a technically feasible, safe and mini-invasive procedure with a low morbidity and acceptable neobladder function. Long-term follow-up is required to confirm the neobladder function and oncological outcomes.
膀胱癌是中国最常见的泌尿系统恶性肿瘤。我们介绍了女性膀胱癌患者行腹腔镜根治性膀胱切除术（LRC）并原位回肠新膀胱术的初步经验和结果。
2003年2月至2008年2月，14例女性膀胱癌患者接受了LRC并原位回肠新膀胱术。其中9例患者接受了子宫切除术和卵巢切除术，另外5例保留了子宫和卵巢附件。先行标准的双侧盆腔淋巴结清扫术，然后进行根治性膀胱切除术，必要时在腹腔镜下完成膀胱切除术并同时行子宫切除术和卵巢切除术。通过下腹部中线4 - 5厘米的切口切除肿瘤，随后构建回肠新膀胱并进行输尿管-新膀胱体外吻合。在腹腔镜下将新膀胱与尿道残端吻合。
14例患者的平均手术时间和失血量分别为350.2分钟和349.8毫升。术后并发症包括1例输尿管-新膀胱吻合口狭窄和1例新膀胱-阴道瘘。所有患者的随访时间为3至60个月，12例患者随访超过6个月且在半年内实现排尿。1例患者偶尔出现日间尿失禁，2例患者出现夜间尿失禁。2例接受子宫切除术和卵巢切除术的患者在1年后出现排尿困难，通过间歇性自我导尿治疗。新膀胱的平均容量和残余尿量分别为333.6毫升和31.2毫升。所有患者手术切缘均无肿瘤。1例患者发生骨转移，术后11个月死亡。
女性患者行LRC并原位回肠新膀胱术是一种技术上可行、安全且微创的手术，发病率低且新膀胱功能可接受。需要长期随访以确认新膀胱功能和肿瘤学结局。
