Popov S V, Skryabin O N, Orlov I N, Suleymanov M M, Kryshevskaya A, Obidnyak V M
) Department of Urology I.I. Mechnikov North-Western State Medical University, St. Peterburg city hospital named after St. Luka, St. Petersburg, Russia.
) North-Estonia Regional hospital, Tallinn, Estonia.
Urologiia. 2019 Apr(1):68-72.
The aim of the study is to compare the results and complications of muscle- invasive bladder cancer treatment using endovideo - surgical radical cycstectomy with orthotopic reservoir formation.
Between 2013 and 2016 years, 49 patients with muscle -invasive bladder cancer underwent endovideo-surgical treatment with orthotopic reservoir formation. 38 patients underwent laparoscopic radical cystectomy with extracorporeal ileal conduit urinary diversioon [ men - 28 (74%), women - 10 (26%)], intracorporeal reservoir were perfomed in 11 cases [men - 8 (73%) and women - 3 (27%)]. The Modified Studer Ileal Neobladder (1st group) was performed in 32 ( 84%) cases, The Hautmann neobladder in 6 (16%) cases. During intracorporeal neobladder formation (2nd group) in all 11 cases Ileal Neobladder was created according to the methods of Karolinska Institutet, ( Sweden).
In the first group 7 (18%) patients had early postoperative complications: in 1 case - Anastomosis failure, 3 patients - Defect of ureteroileal anastomosis and in other 3 cases - Adhesive intestinal obstruction. There was an incidence of late postoperative complications in 6 (15%) cases: 1 patient had exacerbation of chronic pyelonephritis, other 5 patients had stenosis of uretero-ileal anastomosis. Stenosis treatment methods were: in 3 cases - Laser endoureterotomy, and 2 patients underwent Intestinal plastic surgery of the ureter. In the second group 5 (45%) patients had early postoperative complications: in 2 cases - Defect of ureteroileal anastomosis, 2 patients had acute postoperative intestinal obstruction and in 1 case neobladder defect (multiple defects). In this group 4 (36%) patients had late postoperative complications: in 2 cases Stenosis of uretero-ileal anastomosis and other 2 - Active phase of chronic pyelonephritis.
Due to medical technologies development and endovideo-surgical equipment improving, it became possible to perform high-technological operations, such as a laparoscopic radical cystectomy with neobladder formation using different parts of intestine. To imptove the results technical difficulties, postoperative complications and durations of operations were appraised, and we reccomend to perform laparoscopic radical cystectomy with extracorporeal neobladder formation.
本研究的目的是比较采用内镜手术根治性膀胱切除术并构建原位膀胱的肌肉浸润性膀胱癌治疗的结果及并发症。
2013年至2016年期间，49例肌肉浸润性膀胱癌患者接受了内镜手术并构建原位膀胱。38例患者接受了腹腔镜根治性膀胱切除术及体外回肠代膀胱尿流改道术[男性28例（74%），女性10例（26%）]，11例患者进行了体内膀胱构建[男性8例（73%），女性3例（27%）]。32例（84%）患者采用改良Studer回肠新膀胱（第1组），6例（16%）患者采用Hautmann新膀胱。在11例体内新膀胱构建（第2组）中，所有病例均按照瑞典卡罗林斯卡学院的方法构建回肠新膀胱。
第1组7例（18%）患者出现早期术后并发症：1例吻合口失败，3例输尿管回肠吻合口缺损，另3例粘连性肠梗阻。6例（15%）患者出现晚期术后并发症：1例慢性肾盂肾炎加重，另5例输尿管回肠吻合口狭窄。狭窄的治疗方法为：3例激光输尿管内切开术，2例患者接受输尿管肠道整形手术。第2组5例（45%）患者出现早期术后并发症：2例输尿管回肠吻合口缺损，2例急性术后肠梗阻，1例新膀胱缺损（多处缺损）。该组4例（36%）患者出现晚期术后并发症：2例输尿管回肠吻合口狭窄，另2例慢性肾盂肾炎活动期。
由于医学技术的发展和内镜手术设备的改进，开展诸如利用肠道不同部位构建新膀胱的腹腔镜根治性膀胱切除术等高科技手术成为可能。为改善结果，对技术难度、术后并发症及手术时长进行了评估，我们建议进行腹腔镜根治性膀胱切除术并构建体外新膀胱。
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