Tsujii T, Iwai T, Kihara K, Tosaka A, Kawakami S, Masuda H, Wakui M, Oshima H
Department of Urology, Tokyo Medical and Dental University School of Medicine.
Nihon Hinyokika Gakkai Zasshi. 1998 Dec;89(12):979-84. doi: 10.5980/jpnjurol1989.89.979.
There is no consensus on the optimal surgical treatment for patients with concomitant invasive carcinoma of bladder and abdominal aortic aneurysm (AAA). We experienced two patients who were treated successfully with simultaneous radical cystectomy and AAA repair. The techniques required for the combined procedure and case reports are discussed.
The goal of the one-stage operation was to minimize the risk of graft infection without compromising postoperative morbidity and mortality secondary to carcinoma of bladder. Initially pelvic lymph node dissection and radical cystectomy were performed. We preferred retrograde cyctoprostatectomy because most of the cystectomy procedure can be performed without opening the peritoneal cavity and the extent of the retroperitoneal dissection can be minimal. A single-stoma ureterocutaneostomy was preferable urinary diversion. Urinary diversions which utilize intestine such as ileal conduit or ileal urinary reservoir may cause contamination of a graft with bowel content and should be avoided. Before or after urinary diversion, aneurysmal resection and a bifurcated graft replacement were performed. The replaced graft was wrapped with the aneurysmal wall. The major omentum was mobilized and fixed in front of the graft, thereby serving as a protective barrier of the graft. A Dacron graft which was sealed with rifampicin-bonding gelatin was used to further reduce the risk of graft infection.
Two male patients were treated with the one stage radical cystectomy and AAA repair. Single-stoma ureterocutaneostomy and bilateral ureterocutaneostomy were selected as a urinary diversion. No major postoperative complications, except for paralytic ileus in one case, were observed.
Our experience and reports of others indicate that radical cystectomy and simultaneous AAA repair can be safely performed with less morbidity than staged operations for the management of concomitant invasive carcinoma of bladder and AAA.
对于同时患有浸润性膀胱癌和腹主动脉瘤（AAA）的患者，最佳手术治疗方案尚无共识。我们有两例患者成功接受了同期根治性膀胱切除术和AAA修复术。本文讨论了联合手术所需的技术及病例报告。
一期手术的目标是在不增加膀胱癌术后发病率和死亡率的前提下，将移植物感染风险降至最低。首先进行盆腔淋巴结清扫和根治性膀胱切除术。我们更倾向于逆行膀胱前列腺切除术，因为大部分膀胱切除术可以在不打开腹腔的情况下进行，且腹膜后解剖范围可以最小化。单通道输尿管皮肤造口术是首选的尿流改道术。使用肠道的尿流改道术，如回肠导管或回肠储尿囊，可能会导致肠道内容物污染移植物，应避免使用。在尿流改道之前或之后，进行动脉瘤切除和分叉移植物置换。置换的移植物用动脉瘤壁包裹。游离大网膜并固定在移植物前方，从而作为移植物的保护屏障。使用用利福平结合明胶密封的涤纶移植物进一步降低移植物感染风险。
两名男性患者接受了一期根治性膀胱切除术和AAA修复术。选择单通道输尿管皮肤造口术和双侧输尿管皮肤造口术作为尿流改道术。除1例出现麻痹性肠梗阻外，未观察到其他重大术后并发症。
我们的经验及其他报告表明，对于同时患有浸润性膀胱癌和AAA的患者，根治性膀胱切除术和同期AAA修复术可以安全进行，且发病率低于分期手术。
