目的:探讨腹腔镜根治性膀胱切除+原位回肠新膀胱术治疗浸润性膀胱癌的临床疗效.方法:回顾性分析2010年2月至2015年11月于蚌埠医学院第一附属医院行腹腔镜根治性膀胱切除+原位回肠新膀胱术的32例浸润性膀胱癌患者的临床资料,对手术方法(腹腔镜根治性膀胱切除+原位回肠新膀胱术)、围手术期资料、新膀胱功能、术后并发症以及肿瘤控制情况等进行分析.结果:成功随访32例,随访时间12 ～ 53个月,平均随访27个月,均为男性;所有患者手术均由同一术者顺利完成,手术时间310 ～530 min,平均370 min;术中出血300～ 850 ml,平均485 ml;术后3～5天肠道开始恢复功能;淋巴结清扫数目8～31个,平均16个;手术切缘均无阳性结果;术后12个月与6个月相比较,最大尿流率(15.2±1.3vs11.4±1.2 ml,P＜0.01)、最大膀胱容量(372.8±52.2 vs 247.9±60.3 ml,P＜0.01)、残余尿量(23.8 ±9.6 vs 39.6±11.7 ml,P＜0.01)、最大膀胱充盈压(33.7 ±5.7 vs 25.1±6.8 cmH2O,P＜O.01)、最大膀胱排尿压(63.7±15.9 vs62.9±17.6 cmH2O,P＞0.05)、膀胱顺应性(26.2±12.6 vs 25.7±13.3 cmH2O,P＞0.05)以及昼/夜控尿率(91％/81％ vs 84％/72％).术后近期并发症发生率为18.8％(6/32),远期并发症发生率为25.0％(8/32);随访期间,肿瘤局部复发率和远处转移率分别为6.3％ (2/32)和12.5％(4/32).结论:腹腔镜根治性膀胱切除+原位回肠新膀胱术是安全可行的,具有术后控尿效果好、满意的新膀胱功能和肿瘤控制效果等优点,是治疗浸润性膀胱癌的优先选择.%Objective:To investigate the clinical effect of laparoscopic radical cystectomy with orthotopic ileal neobladder in the treatment of invasive bladder cancer.Methods:The clinical data of 32 patients with invasive bladder cancer who underwent laparoscopic radical cystectomy with orthotopic ileal neobladder in the First Affiliated Hospital of Bengbu Medical College from February 2010 to November 2015 were retrospectively analyzed,the operative method (laparoscopic radical cystectomy with orthotopic ileal neobladder),perioperative date,new bladder function,postoperative complications and tumor control were analyzed.Results:32 patients were successfully followed up for 12 ～ 53 months,with an average follow-up of 27 months.All patients were successfully operated on by the same surgeon,operation time were 310 ～ 530 min,average time were 370 min,blood loss were 300 ～ 850 ml,average loss were 485 ml.Intestinal function began to recover after 3 ～5 days.Number of cleaned lymph node 8 ～31,average 16.No positive surgical margins.Twelve months compared with six months after surgery:Maximum urine flow rate (15.2 ± 1.3 vs 11.4 ± 1.2 ml,P ＜ 0.01),maximum bladder capacity (372.8 ± 52.2 vs 247.9 ± 60.3 ml,P ＜ 0.01),residual urine volume (23.8 ± 9.6 vs 39.6 ± 11.7 ml,P ＜ 0.01),maximum bladder filling pressure (33.7 ± 5.7 vs 25.1 ± 6.8 cmH2O,P ＜0.01),maximum bladder pressures during voiding(63.7 ± 15.9 vs 62.9 ± 17.6 cmH2O,P ＞0.05),bladdr compliance (26.2 ± 12.6 vs 25.7 ± 13.3 cmH2O,P ＞ 0.05) and dayight urine control rate (91％/81％ vs 84％/72％).The incidence of early postoperative complications was 18.8％ (6/32),and the incidence of late complications was 25.0％ (8/32).Conclusion:Laparoscopic radical cystectomy with orthotopic ileal neobladder is safe and feasible,with the advantages of good urinary continence,satisfactory bladder function and tumor control effect,is the preferred treatment for invasive bladder cancer.
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