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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:T2N0M028例,T3aN0M014例,T3bN0M08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200～1000ml,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。
Objective: To investigate the surgical method and clinical effect of laparoscopic total cystectomy. Methods: There were 41 males and 9 females, ranging from 52 to 76 years old in 50 cases. Grade Ⅱ ~ Ⅲ of invasive bladder transitional cell carcinoma were confirmed by pathology. TNM staging was T2N0M028 cases, T3aN0M014 cases and T3bN0M08 cases. Laparoscopic total cystectomy, of which 34 cases of primary sigmoid colon debridement and 16 cases of ureteral stoma were observed operation time, intraoperative blood loss, postoperative intestinal function recovery, complications and surgical results. Results: The operation time was 5 ~ 10h, the intraoperative blood loss was 200 ~ 1000ml, the function of intestinal tract recovered at about 72h after operation, the ureter catheter was pulled out 2 weeks after operation, IVU no hydronephrosis, abdominal complications did not occur. Conclusions: Laparoscopic total cystectomy has the characteristics of minimally invasive, less bleeding and rapid recovery. As the technology advances, the procedure will become one of the better ways to treat invasive bladder cancer.