CAJ | 학술논문

目的探讨完全腹腔镜下根治性膀胱切除及原位U形回肠新膀胱术的手术方法及效果.方法 2010年8月至2014年4月,19例临床诊断为局部进展性膀胱癌(cT2～3 N0～2 M0)的患者接受完全腹腔镜下根治性膀胱切除及腔镜下直线切割闭合器形成原位U形回肠新膀胱术,对围手术期及随访资料进行收集.结果 19例完全腹腔镜下根治性膀胱切除以及尿路重建手术均获成功.手术时间(285±37) min,术中出血量(187±36) ml,术后住院时间(21±4)d,术后肠功能恢复时间(1.9±0.4)d.标本切缘均为阴性.淋巴结阳性率32％(6/19).术后发生1例淋巴瘘.3例尿瘘经腹腔引流后治愈.拔除尿管后17例存在尿失禁,均于术后3个月好转,但仍有8例存在夜间尿失禁.3例存在单侧输尿管反流,输尿管轻度积水,其中1例曾于术后1个月内反复感染,经抗炎和导尿治疗后好转.2例存在单侧输尿管吻合口狭窄,其中1例行肾穿刺造瘘后于膀胱镜下置入双J管并留置6个月好转,1例于术后5个月行腹腔镜下输尿管新膀胱再植术后治愈.1例患者术后反复感染后出现双侧输尿管下段狭窄,于术后6个月行腹腔镜下双侧输尿管新膀胱再植手术,一侧行输尿管植入术,对侧行新膀胱壁襻吻合术.术后随访8～42个月,未见复发或远处转移病例.术后6个月膀胱镜检查未见膀胱结石和切割闭合器钉子裸露,肾功能与术前相比无减退.结论完全腹腔镜下根治性膀胱切除加直线切割闭合器原位U形回肠新膀胱术手术创伤小,解剖结构显露较满意;应用直线切割闭合器完成肠道吻合以及新膀胱的制作,手术时间缩短,并发症发生率低,有利于患者术后恢复.
목적 탐토완전복강경하근치성방광절제급원위U형회장신방광술적수술방법급효과.방법 2010년8월지2014년4월,19례림상진단위국부진전성방광암(cT2～3 N0～2 M0)적환자접수완전복강경하근치성방광절제급강경하직선절할폐합기형성원위U형회장신방광술,대위수술기급수방자료진행수집.결과 19례완전복강경하근치성방광절제이급뇨로중건수술균획성공.수술시간(285±37) min,술중출혈량(187±36) ml,술후주원시간(21±4)d,술후장공능회복시간(1.9±0.4)d.표본절연균위음성.림파결양성솔32％(6/19).술후발생1례림파루.3례뇨루경복강인류후치유.발제뇨관후17례존재뇨실금,균우술후3개월호전,단잉유8례존재야간뇨실금.3례존재단측수뇨관반류,수뇨관경도적수,기중1례증우술후1개월내반복감염,경항염화도뇨치료후호전.2례존재단측수뇨관문합구협착,기중1례행신천자조루후우방광경하치입쌍J관병류치6개월호전,1례우술후5개월행복강경하수뇨관신방광재식술후치유.1례환자술후반복감염후출현쌍측수뇨관하단협착,우술후6개월행복강경하쌍측수뇨관신방광재식수술,일측행수뇨관식입술,대측행신방광벽반문합술.술후수방8～42개월,미견복발혹원처전이병례.술후6개월방광경검사미견방광결석화절할폐합기정자라로,신공능여술전상비무감퇴.결론 완전복강경하근치성방광절제가직선절할폐합기원위U형회장신방광술수술창상소,해부결구현로교만의;응용직선절할폐합기완성장도문합이급신방광적제작,수술시간축단,병발증발생솔저,유리우환자술후회복.
Objective To report the surgical methods and results of pure laparoscopic radical cystectomy with orthotopic U-shape ileal neobladder.Methods From August 2010 to April 2014,19 patients with locally advanced bladder cancer (cT2-3 N0-2 M0) underwent pure laparoscopic radical cystectomy and Endo-GIA assisted orthotopic U-shape ileal neobladder reconstruction.Perioperative and follow-up data were collected.Results The surgeries were successful in all 19 cases with the operating time ranging from 261 to 380 min,blood loss of 100 to 350 ml.Postoperative hospital stay was 21±4 (15-26) days,postoperative intestinal function recovery time at 1.9±0.4 (1.5-2.3) days.Surgical margins were all negative.Lymph node positive rate was 32％ (6/19).Complications were including 1 case of lymphatic leakage; 3 cases of new bladder and urethra anastomotic fistula.There were 17 cases of urinary incontinence,all these cases were improved after 3 months,but there were still 8 cases of night-time incontinence.Three cases had unilateral ureteral reflux,ureter mild hydrocephalus,1 of the cases had recurrent infections within 1 month after surgery.After the anti-inflammatory and catheterization treatment,the symptoms were improved.Two cases had unilateral ureteral anastomotic stricture,one underwent percutaneous nephrostomy and cystoscope-assisted double J tube placement,another underwent laparoscopic ureteral neobladder reimplantation.One case had bilateral ureteral stenosis due to recurrent infections,and underwent bilateral laparoscopic ureteral-new bladder reimplantation.Patients were followed up for 8-42 months,no recurrence or distant metastasis was found.Conclusion Pure laparoscopic radical cystectomy with endo-GIA assisted orthotopic U-shape ileal neobladder can reduce surgical trauma and help patient's postoperative recovery.