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目的:改进男性膀胱癌根治性膀胱切除术的手术技术,减少并发症。方法:改进根治性膀胱切除术,包括顺逆性结合的膀胱前列腺切除、输尿管远端冰冻活检、缝扎背深静脉、保护神经血管束、广泛盆腔淋巴结清扫等。对62例患者临床资料进行回顾性分析。结果:患者平均年龄67岁,膀胱前列腺切除及淋巴清扫的手术时间2.2~3.5h,平均2.5h。术中出血量150~1200ml,平均400ml。62例中7例(11.3%)术中冷冻切片证实输尿管残端有肿瘤细胞浸润或上皮细胞不典型增生。切除淋巴结8~16枚/例,阳性率16.1%(10/62)。本组术后6例有轻度肠梗阻,对症治疗好转;1例切口部分脂肪液化,无肺、盆腔感染,无直肠损伤等并发症,无一例围手术期死亡。随访3~52个月,1例术后5个月骨转移死亡,余均未发现盆腔、吻合口及其他脏器的远处转移。有意保留神经血管束的10例,其中4例有勃起功能;无意保留神经血管束,术后有勃起功能者3例(随访30例)。结论:改进的根治性膀胱切除术可有效根治性切除肿瘤,可减少术中后出血,降低并发症发生率。
Objective: To improve the surgical technique of radical cystectomy in male bladder cancer and reduce the complications. Methods: To improve the radical cystectomy, including the cis-reversal of bladder resection, distal ureter frozen biopsy, sutured deep vein, protect the neurovascular bundle, extensive pelvic lymph node dissection and so on. The clinical data of 62 patients were retrospectively analyzed. Results: The mean age of patients was 67 years old. The operation time of bladder resection and lymph node dissection was 2.2 ~ 3.5 hours with an average of 2.5 hours. Intraoperative blood loss of 150 ~ 1200ml, with an average of 400ml. Of the 62 cases, 7 (11.3%) intraoperative frozen sections confirmed the presence of tumor cell infiltration or epithelial dysplasia in the stump of the ureter. Excision of lymph nodes 8 to 16 / case, the positive rate of 16.1% (10/62). 6 cases of this group had mild intestinal obstruction, symptomatic treatment improved; 1 case of incision fat liquefaction, no lung, pelvic infection, no rectal injury and other complications, no case of perioperative death. All patients were followed up for 3 to 52 months. One patient died of bone metastasis 5 months after operation. No pelvic, anastomotic and other distant metastases were found. There were 10 cases of neurovascular bundles intentionally reserved, of which 4 cases had erectile function. There was no intention of preserving the neurovascular bundles and 3 cases had postoperative erectile function (up to 30 cases). Conclusion: The modified radical cystectomy can effectively remove the tumor by radical resection, reduce postoperative bleeding and reduce the incidence of complications.