Sangkum Premsant, Patcharatrakul Suthep, Khongchareonsombat Wisoot
Division of Urology, Department of Surgery, Ramathibodi Hospital, Mahidol University Bangkok, Thailand.
J Med Assoc Thai. 2013 May;96(5):564-8.
Laparoscopic radical cystectomy is now widely performed in cases of muscle-invasive bladder cancer. The present study experience with laparoscopic radical cystectomy using an ileal neobladder in which urethra-neobladder anastomosis was successfully performed intracorporeally
Between March and November 2009, five patients underwent laparoscopic radical cystectomy using an ileal neobladder with urethra-neobladder anastomosis. Preoperative characteristics, operative data, and results were analyzed.
The operation was successful for all patients. The mean operative time was 6 hours and 30 minutes. Mean estimated blood loss was 560 ml. No intraoperative complications occurred. Mean hospital stay was 19.6 days. Mean Foley catheter indwelled time was 18 days. Return of bowel function took 4.8 days. Mean time to remove silastic drain was 14.2 days. After Foley catheter removal, all patients spontaneously voided without difficulty.
Laparoscopic radical cystectomy of ileal neobladders using intracorporeal urethra-neobladder anastomosis is technically feasible. This technique takes advantage of laparoscopic surgery, good visualization, additional stitches, and more secure anastomosis.
腹腔镜根治性膀胱切除术目前在肌层浸润性膀胱癌病例中广泛开展。本研究介绍了使用回肠新膀胱进行腹腔镜根治性膀胱切除术并成功在体内完成尿道-新膀胱吻合术的经验。
2009年3月至11月期间，5例患者接受了使用回肠新膀胱并进行尿道-新膀胱吻合术的腹腔镜根治性膀胱切除术。对术前特征、手术数据及结果进行了分析。
所有患者手术均成功。平均手术时间为6小时30分钟。平均估计失血量为560毫升。未发生术中并发症。平均住院时间为19.6天。平均留置导尿管时间为18天。肠功能恢复时间为4.8天。平均拔除硅胶引流管时间为14.2天。拔除导尿管后，所有患者均能自主排尿且无困难。
采用体内尿道-新膀胱吻合术的腹腔镜回肠新膀胱根治性膀胱切除术在技术上是可行的。该技术利用了腹腔镜手术的优势，视野良好，缝合线更多，吻合更安全。
