Colombo Jose R, Desai Mihir, Canes David, Frota Rodrigo, Haber Georges-Pascal, Moinzadeh Alireza, Tuerk Ingolf, Desai Mahesh R, Gill Inderbir S
Section of Laparoscopic and Robotic Surgery, Cleveland Clinic, Glickman Urological Institute, Cleveland, Ohio, USA.
Clinics (Sao Paulo). 2008 Dec;63(6):731-4. doi: 10.1590/s1807-59322008000600004.
To report our initial experiences with laparoscopic partial cystectomy for urachal and bladder malignancy.
Between March 2002 and October 2004, laparoscopic partial cystectomy was performed in 6 cases at 3 institutions; 3 cases were urachal adenocarcinomas and the remaining 3 cases were bladder transitional cell carcinomas. All patients were male, with a median age of 55 years (45-72 years). Gross hematuria was the presenting symptom in all patients, and diagnosis was established with trans-urethral resection bladder tumor in 2 patients and by means of cystoscopic biopsy in the remaining 4 patients. Laparoscopic partial cystectomy was performed using the transperitoneal approach under cystoscopic guidance. In each case, the surgical specimen was removed intact entrapped in an impermeable bag. One patient with para-ureteral diverticulum transitional cell carcinoma required concomitant ureteral reimplantation.
All six procedures were completed laparoscopically without open conversion. The median operating time was 110 minutes (90-220) with a median estimated blood loss of 70 mL (50-100). Frozen section evaluations of bladder margins were routinely obtained and were negative for cancer in all cases. The median hospital stay was 2.5 days (2-4) and the duration of catheterization was 7 days. There were no intraoperative or postoperative complications. Final histopathology confirmed urachal adenocarcinoma in 3 cases and bladder transitional cell carcinoma in 3 cases. At a median follow-up of 28.5 months (range: 26 to 44 months), there was no evidence of recurrent disease as evidenced by radiologic or cystoscopic evaluation.
Laparoscopic partial cystectomy in carefully selected patients with urachal and bladder cancer is feasible and safe, offering a promising and minimally invasive alternative for these patients.
报告我们在腹腔镜下对脐尿管及膀胱恶性肿瘤行部分膀胱切除术的初步经验。
2002年3月至2004年10月期间，3家机构对6例患者实施了腹腔镜下部分膀胱切除术；其中3例为脐尿管腺癌，其余3例为膀胱移行细胞癌。所有患者均为男性，中位年龄55岁（45 - 72岁）。所有患者均以肉眼血尿为首发症状，2例患者经尿道膀胱肿瘤切除术确诊，其余4例经膀胱镜活检确诊。在膀胱镜引导下采用经腹途径实施腹腔镜下部分膀胱切除术。每例手术标本均完整取出并装入不透水袋中。1例输尿管旁憩室移行细胞癌患者需同时行输尿管再植术。
所有6例手术均在腹腔镜下完成，未中转开放手术。中位手术时间为110分钟（90 - 220分钟），中位估计失血量为70毫升（50 - 100毫升）。常规对膀胱切缘进行冰冻切片评估，所有病例均未发现癌细胞。中位住院时间为2.5天（2 - 4天），导尿时间为7天。无术中及术后并发症。最终组织病理学检查证实3例为脐尿管腺癌，3例为膀胱移行细胞癌。中位随访28.5个月（范围：26至44个月），经影像学或膀胱镜评估，无疾病复发迹象。
对于精心挑选的脐尿管及膀胱癌患者，腹腔镜下部分膀胱切除术是可行且安全的，为这些患者提供了一种有前景的微创替代方案。
