世界首例单孔腹腔镜根治性膀胱切除全去带-南方医科大学学报.PDF

2010;30(6) 南方医科大学学报(JSouthMedUniv) 窑1385窑 世界首例单孔腹腔镜根治性膀胱切除尧全去带乙状结肠原位新膀胱术 刘春晓袁徐啊白袁陈玢屾袁郑少波袁李虎林袁徐亚文渊南方医科大学珠江医院泌尿外科袁广东 广州 510282冤 摘要院目的报告世界首例单孔腹腔镜渊LESS冤根治性膀胱切除术袁并采用全去带乙状结肠构建原位膀胱遥方法患者为74 岁男性袁因血尿2 月入院袁活检病理确诊为膀胱癌遥行LESS根治性膀胱切除术袁于下腹正中取3.5cm纵形切口袁置入单 孔多通道套管渊R-port冤建立手术入路遥手术过程包括双侧盆腔淋巴结清扫遥根治性膀胱切除术完成后袁开放构建全去带 乙状结肠原位新膀胱遥结果手术总时间9.5h袁LESS部分5.5h遥术中采用传统腹腔镜器械袁没有增加其它通道遥最终病 理结果为尿路上皮癌遥 术中失血约600ml袁输注红细胞400ml遥 清扫的盆腔淋巴结均为阴性遥 尿道及输尿管切缘未见 肿瘤侵犯遥围手术期未发生水电平衡紊乱及酸碱失衡遥术后3月复查袁未见肿瘤复发和远处转移袁新膀胱容量约280ml袁 残余尿10ml袁最大尿流率 11.1ml/s遥 结论尽管LESS手术有着更长的学习曲线袁但有望成为治疗浸润性膀胱肿瘤的更 加微创更美观的手术方法遥 关键词院单孔腹腔镜曰膀胱肿瘤曰根治性膀胱切除术曰新膀胱曰乙状结肠 中图分类号院R699.5 文献标识码院A 文章编号院1673-4254(2010)06-1385-04 Laparoendoscopic single-site surgery radical cystectomy with orthotopic taenia myectomy sigmoidneobladder:initialreport LIUChun-xiao,XUA-bai,CHENBin-shen,ZHENGShao-bo,LIHu-lin,XUYa-wen DepartmentofUrology,ZhujiangHospital,SouthernMedicalUniversity,Guangzhou510282,China Abstract:Objective Toreportthefirstcaseanddetailedtechniquesoflaparoendoscopicsingle-sitesurgery(LESS) radical cystectomywithorthotopictaeniamyectomysigmoidneobladderfororgan-confinedbladdercancer. MethodsA74-year-old manpresentedwithgrosshematuriafor2monthsandbiopsyrevealedbladdercancer. LESSradicalcystectomyandbilateral pelviclymphadenectomieswereperformedusingasinglemultilumenportinsertedthroughasolitary3.5cmlowerabdominal incision with conventional laparoscopicinstruments. Thetaeniamyectomysigmoidpouch was then constructedbyopen procedure. ResultsThetotaloperativetimewas9.5h,andtheLESSprocedurelastedforabout5.5h.Nootherportincision wasadded.Thefinalpathologyrevealedurothelialcarcinoma.Theestimatedintraoperativebloodlosswas600mlwithblood transfusionof400ml. Thepelviclymphnodesandthesurgicalmarginsoftheuretersandurethrawereallfreeoftumor invasion. Nowaterelectrolyteandmetabolicacid-basebalancedisorderswereobservedp