Lin Tian-Xin, Huang Jian, Xu Ke-Wei, Jiang Chun, Huang Hai, Han Jin-Li, Zhang Cai-Xia, Yao You-Sheng, Xie Wen-Lian, Guo Zheng-Hui, Yin Xin-Bao, Dong Wen
Department of Urology, Second Affiliated Hospital of Sun Yat-sen University, Guangzhou 510120, China.
Zhonghua Yi Xue Za Zhi. 2008 Sep 9;88(34):2437-40.
To analyze the effects, complication, and outcome of laparoscopic radical cystectomy.
108 patients with bladder cancer, 96 males and 12 females, aged 61 (36 - 81) underwent laparoscopic radical cystectomy with orthotopic ileal neobladder. Five-port transperitoneal approach was applied. The surgical procedure included standard laparoscopic pelvic lymphadenectomy, radical resection of bladder, extracorporeal formation of ileal pouch; extracorporeal implantation of ureters; and laparoscopic urethra-neobladder anastomosis. Erectile nerve sparing procedure was performed for 26 cases. The patients were followed up for 1 - 53 months.
The median operation time was 330 min, and the median blood loss was 320 ml. Conversion to open surgery was not necessary in any of the patients. There was no peri-operative mortality. The complication rate was 18.5% (20/108). Surgical margins were tumor free for all cases. The day-time and night-time continence rates were 90.7% and 82.6% respectively in 6 months postoperatively. 10 of the 26 patients undergoing erectile nerve-sparing procedure had potency for intercourse. Follow-up showed 5 cases with local recurrence, 1 case with trocar site seeding and 6 cases with distant metastasis, 8 of the patients died of tumor-related disease and 3 died of diseases not related to tumor.
Laparoscopic radical cystectomy with extracorporeal formation of orthotopic ileal neobladder is a feasible technique with low morbidity and acceptable neobladder function.
分析腹腔镜根治性膀胱切除术的疗效、并发症及预后。
108例膀胱癌患者，男96例，女12例，年龄61岁（36 - 81岁），接受腹腔镜根治性膀胱切除术并原位回肠新膀胱术。采用五孔经腹途径。手术步骤包括标准腹腔镜盆腔淋巴结清扫、膀胱根治性切除、回肠袋体外成型、输尿管体外植入以及腹腔镜尿道-新膀胱吻合术。对26例患者实施了保留勃起神经手术。患者随访1 - 53个月。
中位手术时间为330分钟，中位失血量为320毫升。所有患者均无需转为开放手术。无围手术期死亡。并发症发生率为18.5%（20/108）。所有病例手术切缘均无肿瘤。术后6个月白天和夜间控尿率分别为90.7%和82.6%。26例接受保留勃起神经手术的患者中有10例恢复性交功能。随访显示5例局部复发，1例穿刺孔种植转移，6例远处转移，8例患者死于肿瘤相关疾病，3例死于与肿瘤无关的疾病。
腹腔镜根治性膀胱切除术并体外原位回肠新膀胱术是一种可行的技术，并发症发生率低，新膀胱功能可接受。
