Niu Yi-nong, Xing Nian-zeng, Lang Jin-tian, Zhang Jun-hui, Kang Ning, Tian Xi-quan, Wang Jian-wen
Department of Urology, Beijing Chaoyang Hospital, Capital Medical University, Beijing 100020, China.
Zhonghua Yi Xue Za Zhi. 2011 Jun 28;91(24):1702-4.
To summarize the preliminary experiences of 13 cases of laparoscopic radical cystectomy and construction of orthotopic T pouch ileal neobladder and evaluate the oncological and functional outcomes of this procedure.
From August 2005 through July 2009, 13 patients underwent radical cystectomy and standard lymphadenectomy followed by construction of orthotopic T pouch ileal neobladder via mini-laparotomy for muscular invasive bladder cancer. The data were analyzed according to procedure time, blood loss volume, transfusion volume, number of dissected lymph nodes, peri-operative complications, morphology and function of upper urinary tract and status of urinary continence.
The mean operating duration was 6 (5 - 8) hours, estimated volume of blood loss 480 (100 - 800) ml, transfusion volume 133 (0 - 400) ml and the number of dissected lymph nodes 16 (8 - 22). There was no peri-operative mortality. The peri-operative complications were found in 15.4% (2/13) and included urine leak at neobladder-urethra junction managed by drainage (n = 1) and urine leak at ureter-neobladder junction repaired (n = 1). The complete daytime continence rate was 84.6% (11/13), complete nocturnal continence rate 46.1% (6/13) and < 1 pad in 30.8% (4/13). No reflux into afferent limb of neobladder was observed by cystography. Temporary dilation of upper urinary tract was observed in 23.1% (3/13) at Day 45 post-operation and later it disappeared spontaneously. Serum creatinine remained in a normal range in all patients. Within a follow-up of 24 (16 - 63) months, 7.7% (1/13) died of myocardial infarction at Month 55 post-operation. And 92.3% (12/13) survived without a local relapse or a distal metastasis.
Within an intermediate follow-up period, the oncological and functional outcomes are encouraging after laparoscopic radical cystectomy and construction of orthotopic T pouch ileal neobladder via mini-laparotomy. The anti-reflux mechanism is effective to preserve the morphology and function of upper urinary tract.
总结13例腹腔镜根治性膀胱切除术及原位T形回肠新膀胱构建的初步经验，并评估该手术的肿瘤学及功能学结果。
2005年8月至2009年7月，13例肌层浸润性膀胱癌患者接受了根治性膀胱切除术及标准淋巴结清扫术，随后经小切口剖腹术构建原位T形回肠新膀胱。根据手术时间、失血量、输血量、清扫淋巴结数量、围手术期并发症、上尿路形态及功能以及尿失禁情况对数据进行分析。
平均手术时长为6（5 - 8）小时，估计失血量480（100 - 800）毫升，输血量133（0 - 400）毫升，清扫淋巴结数量16（8 - 22）枚。无围手术期死亡病例。围手术期并发症发生率为15.4%（2/13），包括新膀胱 - 尿道吻合口漏，经引流处理（n = 1），以及输尿管 - 新膀胱吻合口漏，予以修复（n = 1）。白天完全控尿率为84.6%（11/13），夜间完全控尿率为46.1%（6/13），30.8%（4/13）患者使用尿垫数量<1片。膀胱造影未观察到新膀胱输入襻反流。术后45天时，23.1%（3/13）患者出现上尿路暂时扩张，随后自行消失。所有患者血清肌酐均保持在正常范围内。在24（16 - 63）个月的随访期内，1例（7.7%，1/13）患者于术后55个月死于心肌梗死。92.3%（12/13）患者存活，无局部复发或远处转移。
在中期随访期内，腹腔镜根治性膀胱切除术及经小切口剖腹术构建原位T形回肠新膀胱后的肿瘤学及功能学结果令人鼓舞。抗反流机制有效地保留了上尿路的形态及功能。
