CAJ | 학술논문

目的：探讨腹腔镜根治性膀胱切除术及直肠代膀胱术的手术方法和临床疗效。方法收集本单位2011年10月至2014年6月采用腹腔镜根治性膀胱切除术及直肠代膀胱术的37例膀胱癌患者的临床资料，观察手术时间、术中出血量、术后肠道功能恢复、住院时间、术后并发症及手术效果，并进行统计分析。结果37例患者的手术均成功完成。手术时间（230±55）分钟，术中出血量（320±110）ml，术后肠蠕动恢复时间为（4±2）天，术后拔除引流管时间为（7±2）天，术后拔除输尿管支架管时间为（13±3）天，术后住院天数为（18±3）天。1例患者术后2月出现粘连性肠梗阻，其余均未出现感染、肠瘘和术后出血等严重手术并发症。术后随访2～36个月，1例死于原发病转移，余患者未见肿瘤复发或远处转移。术后患者排尿通畅，未出现排尿困难；直肠膀胱功能正常，肾功能正常。结论腹腔镜根治性膀胱切除术及直肠代膀胱术创伤小、出血少、恢复快，但操作难度大，是治疗浸润性膀胱癌的一种有效方法。
목적：탐토복강경근치성방광절제술급직장대방광술적수술방법화림상료효。방법수집본단위2011년10월지2014년6월채용복강경근치성방광절제술급직장대방광술적37례방광암환자적림상자료，관찰수술시간、술중출혈량、술후장도공능회복、주원시간、술후병발증급수술효과，병진행통계분석。결과37례환자적수술균성공완성。수술시간（230±55）분종，술중출혈량（320±110）ml，술후장연동회복시간위（4±2）천，술후발제인류관시간위（7±2）천，술후발제수뇨관지가관시간위（13±3）천，술후주원천수위（18±3）천。1례환자술후2월출현점련성장경조，기여균미출현감염、장루화술후출혈등엄중수술병발증。술후수방2～36개월，1례사우원발병전이，여환자미견종류복발혹원처전이。술후환자배뇨통창，미출현배뇨곤난；직장방광공능정상，신공능정상。결론복강경근치성방광절제술급직장대방광술창상소、출혈소、회복쾌，단조작난도대，시치료침윤성방광암적일충유효방법。
Objective To evaluate the surgical technique and clinical efficacy of laparoscopic radical cystec-tomy and rectum pouch for urinary diversion. Methods From October 2011 to June 2014,37 patients with inva-sive bladder cancer were treated with laparoscopic radical cystectomy and rectum pouch for urinary diversion. The operation time,the blood loss,the intestine function recovery time and the complication were observed. Re-sults All operations were successful,with the operation time being (230 ± 55)minutes,the blood loss (320 ± 110)ml. Recovery of bowel movement occurred (4 ± 2)days after surgery and the postoperative hospital stay was (18 ± 3)days. No severe intraoperative and postoperative complications,such as intestinal fistula and hem-orrhage,occurred,except that one patient suffered adhesive intestinal obstruction. After 2~36 months of follow-up,there was no case of recurrence and metastasis,except 1 case died of primary disease metastasis. All pa-tients urinated normally and the function of rectum pouch was regular. Conclusions Laparoscopic radical cyctec-tomy and rectum pouch for urinary diversion is a safe,effective and feasible but technically challenging alterna-tive for invasive bladder cancer.