CAJ | 학술논문

目的探讨腹腔镜下全膀胱切除+全去带乙状结肠原位新膀胱术治疗高龄(≥70岁)膀胱癌患者的安全性和有效性. 方法回顾性分析2002年8月至2012年7月收治的63例膀胱癌患者的临床资料.男52例,女11例.年龄70～ 87岁,平均74岁.所有患者均经膀胱镜活检确诊为膀胱恶性肿瘤.临床分期:T1N0M0期4例,T2N0M0期59例.均在气管内全麻下行腹腔镜下全膀胱切除+全去带乙状结肠原位新膀胱术治疗. 结果本组63例,手术时间220 ～ 520 min,平均358 min.术中出血量150～800 ml,平均425 ml.总输血量0～1 200 ml,平均377 ml.随访3～ 76个月,平均43个月.54例术后随访1年,日间控尿率87.0％(47/54),夜间控尿率59.3％ (32/54).41例行尿动力学检查,储尿囊排空尿量160～ 470 ml,平均309 ml;储尿囊功能状态最大压力10～63 cmH2O(1 cmH2O=0.098 kPa),平均16 cmH2O;最大尿流率7～39 ml/s,平均17 ml/s;残余尿量0～70 ml,平均13 ml.围手术期(术后12d内)病死率3.2％(2/63).早期(术后3个月内)并发症22例(36.1％,22/61)共25例次:切口感染及愈合不良、不完全性肠梗阻各6例,尿瘘4例,肠瘘3例,新膀胱尿道吻合口狭窄2例,应激性溃疡、严重感染、大出血、新膀胱阴道瘘各1例.远期并发症(术后3个月以上)19例(36.5％,19/52)共21例次:新膀胱尿道吻合口狭窄伴肾积水6例;不伴明显尿道吻合口狭窄的轻度泌尿系积水4例;新膀胱输尿管吻合口狭窄伴肾积水3例;肾结石、新膀胱结石各2例.肿瘤复发并转移2例,分别为新膀胱新发肿瘤和左肾盂癌各1例.1年肿瘤特异性病死率为3.7％ (2/54),5年肿瘤特异性病死率为9.5％(2/21). 结论高龄患者行腹腔镜下全膀胱切除+全去带乙状结肠原位新膀胱术安全、有效.
목적 탐토복강경하전방광절제+전거대을상결장원위신방광술치료고령(≥70세)방광암환자적안전성화유효성. 방법 회고성분석2002년8월지2012년7월수치적63례방광암환자적림상자료.남52례,녀11례.년령70～ 87세,평균74세.소유환자균경방광경활검학진위방광악성종류.림상분기:T1N0M0기4례,T2N0M0기59례.균재기관내전마하행복강경하전방광절제+전거대을상결장원위신방광술치료. 결과 본조63례,수술시간220 ～ 520 min,평균358 min.술중출혈량150～800 ml,평균425 ml.총수혈량0～1 200 ml,평균377 ml.수방3～ 76개월,평균43개월.54례술후수방1년,일간공뇨솔87.0％(47/54),야간공뇨솔59.3％ (32/54).41례행뇨동역학검사,저뇨낭배공뇨량160～ 470 ml,평균309 ml;저뇨낭공능상태최대압력10～63 cmH2O(1 cmH2O=0.098 kPa),평균16 cmH2O;최대뇨류솔7～39 ml/s,평균17 ml/s;잔여뇨량0～70 ml,평균13 ml.위수술기(술후12d내)병사솔3.2％(2/63).조기(술후3개월내)병발증22례(36.1％,22/61)공25례차:절구감염급유합불량、불완전성장경조각6례,뇨루4례,장루3례,신방광뇨도문합구협착2례,응격성궤양、엄중감염、대출혈、신방광음도루각1례.원기병발증(술후3개월이상)19례(36.5％,19/52)공21례차:신방광뇨도문합구협착반신적수6례;불반명현뇨도문합구협착적경도비뇨계적수4례;신방광수뇨관문합구협착반신적수3례;신결석、신방광결석각2례.종류복발병전이2례,분별위신방광신발종류화좌신우암각1례.1년종류특이성병사솔위3.7％ (2/54),5년종류특이성병사솔위9.5％(2/21). 결론 고령환자행복강경하전방광절제+전거대을상결장원위신방광술안전、유효.
Objective To evaluate the safety and efficacy of orthotopic taenia myectomy sigmoid neobladder for elderly patients (≥ 70 years old) with bladder cancer after laparoscopic radical cystectomy.Methods We retrospectively analyzed the clinical data of 63 elderly patients with bladder cancer,including 52 males and 11 females with mean age 74 years old (ranged 70-87 years old),who had accepted orthotopic taenia myectomy sigmoid neobladder after the laparoscopic radical cystectomy under general anesthesia from August 2002 to July 2012.The clinic stage in those patients included T1N0M0 in 4 cases and T2N0M0 in 59 cases.Results The mean operative duration,intraoperative blood loss,volume of blood transfusion were 358 min (220-520 min),425 ml (150-800 ml),377 ml (0-1 200 ml) ml and 96.8％,respectively.Follow-up period ranged from 3 to 76 months (mean 43 months).54 patients were followed up longer than 1 year.The daytime and nighttime continence rate were 87.0 ％ (47/54) and 59.3％ (32/54),respectively.41 cases underwent urodynamic studies.The mean voided volume,maximal pressure of bladder in functional state,maximal flow rate and post-void residual volume were 309 ml (160-470 ml),16 cmH20 (10-63emH2O),17 ml/s (7-39 ml/s) and 13 ml (0-70 ml),respectively.Mortality rate in perioperative period (within 12 days after surgery) was 3.2 ％ (2/63).Early (within 3 months after surgery) complications in 22 cases (36.1％,22/61),including six cases of wound infection,six cases of incomplete intestinal obstruction,four cases of urinary fistula,1 case of stress ulcer,1 case of severe infections,1 case of bleeding,3 cases of intestinal fistula,2 cases of urethral anastomotic stenosis,1 case of vesicovaginal fistula.Longterm (longer than 3 months after surgery) complications in 19 patients (36.5％,19/52),including six cases of urethro-vesical anastomotic stenosis with hydronephrosis,four cases of mild hydronephrosis without the evidence of urethro-vesical anastomotic stenosis,three cases of uretero-vesical anastomotic stenosis with hydronephrosis,2 cases of kidney stone,2 cases of neo-bladder stone,two cases of tumor recurrence and metastasis,one case of new tumors in neobladder,one case of the left renal pelvic carcinoma.Tumor-specific mortality was 3.7％ (2/54) in the patients with 1-year follow up.Tumor-specific mortality was 9.5％ (2/21)in the patients with 5-year follow up.Conclusions Orthotopic taenia myectomy sigmoid neobladder after laparoscopic radical cystectomy in elderly patients is safe and efficacy.