腹腔镜下根治性膀胱切除回肠通道术_医学论文.docVIP

腹腔镜下根治性膀胱切除回肠通道术_医学论文 腹腔镜下根治性膀胱切除回肠通道术_医学论文 作者：陈建刚 钱麟 郑兵 陆明 朱华 顾栋华　汤纪元 潘彬 张冰 任展 殷长军 【摘要】 目的 探讨腹腔镜下根治性膀胱切除回肠通道术的术式。方法 浸润性膀胱癌患者8例，男性6例，女性2例，年龄59~75岁，平均年龄67岁。腹腔镜下根治性膀胱切除，下腹正中4~5 cm切口取出标本，行回肠通道术。结果 手术时间5~7 h，平均5.5 h,其中腹腔镜下操作时间190~260 min，平均215 min。出血量200~400 ml，平均260 ml。均未出现围手术期并发症，术后随访1~16个月，1例患者术后1个月复查发现输尿管吻合口狭窄，其余患者肾功能均正常，IVU检查未发现输尿管回肠吻合口狭窄或输尿管返流。结论 腹腔镜下膀胱根治性切除回肠通道术创伤小、手术时间短、恢复快，是膀胱全切除中的对于老年患者适合开展的术式。 【关键词】 膀胱肿瘤；腹腔镜；回肠通道术 Abstract: Objective To present some experience in laparoscopic radical cystectomy with ileal conduit. Methods Eight patients (6 male and 2 female) with invasive bladder carcinoma were treated by laparoscopic radical cystectomy with ileal conduit from June 2006 to December 2007. The mean age was 67 years (range 59 to 75 years). A 4-5 cm suprapubic incision was made to remove the bladder. The Ileal conduit was constructed routinely. Results The surgery lasted 5 to 7 h (mean 5.5 h), with laparoscopic surgery having taken 190 to 260 min (mean 215 min). The blood loss was 200 to 400 ml (mean 260 ml). No perioperative complications were encountered. Follow-up for 1 to 16 months revealed only 1 case of ureteral obstruction and no evidence of ureteral reflux or ureteral obstruction in intravenous urography. Conclusion With the improvement of surgical technique, laparoscopic radical cystectomy with ileal conduit has become a surgery of choice for old patients, because of its little trauma, short operating time and rapid recovery. Key words: bladder neoplasms laparoscopy Ileal conduit 腹腔镜技术目前在泌尿外科有着广泛的运用，随着腹腔镜操作技术的熟练，腹腔镜下膀胱全切所用时间逐渐减少，有逐步取代开放切除趋势。本院于2006年6月—2007年12月为8例浸润性膀胱癌患者行腹腔镜根治性膀胱切除回肠膀胱术，均获成功，报告如下。 1 资料和方法 1.1 临床资料 本组8例，男性6例，女性2例。年龄59~75岁，平均年龄67岁。均行膀胱镜检查及CT检查证实为浸润性膀胱癌患者，8例移行细胞癌（Ⅱ级2例，Ⅱ~Ⅲ级3例，Ⅲ级3例）TNM分期：T2N0M0 3例，T3N0M0 5例。其中1例曾行膀胱肿瘤电切术。所有病例均无远处转移及盆腔淋巴结转移。完善术前检查，术前肠道准备。 1.2 手术方法 1.2.1 麻醉、体位和套管针穿刺位置 采用全麻加连续硬膜外麻醉，仰卧位，臀部垫高10 cm，头部降低倾斜15°。采用5点穿刺法：第1穿刺点位于脐上边缘，插入10 mm套管针；第2、3穿刺点分别在左、右腹直肌旁脐下2 cm处，插入12 mm套管针；第4、5穿刺点为左、右髂前上棘向内2 cm处，插入5 mm套管针。 1.2.2