腹腔镜下全膀胱切除术(附50例报告).docVIP

腹腔镜下全膀胱切除术（附50例报告） 　　作者：汪清,杨建昆,张,宇,王胜军,马力克o伊　　作者单位：新疆维吾尔自治区人民医院,新疆 乌鲁木齐，830001 　　【摘要】 目的：探讨腹腔镜下全膀胱切除术的手术方法和临床效果。方法：50例患者中男41例，女9例，52～76岁;经病理证实为浸润性膀胱移行细胞癌Ⅱ～Ⅲ级,TNM 分期:T2N0M0 28例,T3aN0M0 14 例,T3bN0M0 8例。行腹腔镜下全膀胱切除术，其中34例行原位乙状结肠代膀胱术,16例行输尿管造口术,观察手术时间，术中出血量，术后肠道功能恢复、并发症及手术效果。结果：手术时间5～10h,术中出血200～1 000ml，术后约72h肠道功能恢复,术后2周拔输尿管导管,术后3周拔尿管后腹压排尿正常,术后3个月IVU未见肾积水，未发生腹腔并发症。结论：经腹腹腔镜全膀胱切除术，具有微创、出血少、恢复快等特点,随着技术的进步,该术式将成为治疗浸润性膀胱癌的较好方法之一。 　　【关键词】 腹腔镜术;膀胱癌;全膀胱切除术 　　Laparoscopic radical cystectomy for carcinoma of bladder:a report of 40 cases WANG Qing,YANG Jiankun,ZHANG Yu,et al.Second Dept.of Urology,the Peoples Hospital,Xinjiang Uygur Autonomous Region,Urumqi 830001,China 　　【Abstract】 Objective:To evaluate the surgical technique and clinical efficacy of laparoscopic radical cystectomy for bladder cancer.Methods:There were 41 male and 9 female,5276 years old (mean 66.8 years).The pathological reports of 50 cases showed transitional cell carcinoma ⅡⅢ grade;34 cases were performed laparoscopic radical cystectomy with reconstruction of bladder with sigmoid,16 cases were performed ureterostomy,and we recorded the operation time,the blood loss,the intestine function recovery time and the complication.Results:All operations were successful with the operation time 510h,the blood loss 2001 000ml (mean 360ml).The intestine function recovered about 72h after operation.All ureteral catheters were removed 2 weeks after surgery.Urethral catheter was removed 3 weeks after surgery,the patients were able to urinate by abdominal pressure,and the IVU showed no abnormality 3 months after surgery.Conclusions:Laparoscopic radical cystectomy for invasive bladder cancer is a safe and efficient method,with advantages of good operating field,minimal invasion,less celiac complications,short hospital stay and rapid recovery.It is worth to be widespread. 　　【Key words】 Laparoscopy;Bladder cancer;Radical cystectomy 　　近年来腹腔镜在泌尿外科领域获得迅速发展， 自1992年腹腔镜下全膀胱切除术报道[1]以来，能否在腹腔镜下行全膀胱切除一直是国内外关注的问